(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Children's Library | Biodiversity Heritage Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "Annual report of the State Board of Health of the State of Maine"



(T* 



. Eftl^ 



Columbia S^nitJersittp 

College of ^ijpgicians! anJj iburgeonsi 
Hibrarp 













O 
O 



SECOND ANNUAL REPORT 



OF THE 



State Board of Health 



OP THE 



STATE OF MAINE, 



For the Fiscal Year Ending December 31, 1886. 



AUGUSTA : 

SPRAGUS 4 SON, PRINTERS TO THE STATE. 

1887. 



Digitized by tine Internet Arciiive 

in 2010 witii funding from 
Columbia University Libraries 



http://www.archive.org/details/annualreportofst1886main 



MAINE STATE BOAED OF HEALTH. 



Office of the Secretary, \ 
Augusta, Maine, April 4, 1887. j 

To His Excellency, Jos. R. Bodwell^ Oovemor, and the Honorable 
Executive Council: 

Gentlemen : — I have the honor of submitting to you the Second 
Annual Report of the State Board of Health of Maine. 
Very respectfully, 

A. G. YOUNG, M. D., 

Secretary. 



8-1-568 



MEMBERS OF THE BOARD. 



FREDERIC H. GERRISH, m. d., President, Portland. 

Hon. lewis BARKER, Bangor. 

Hon. STEPHEN J. YOUNG, Brunswick. 

O. A. HORR, M. D., Lewiston. 

E. C. JORDAN, c. E., Portland. 

J. O. WEBSTER, M. D., Augusta. 

A. G. YOUNG, M. D., Secretary, Augusta. 



CONTENTS. 



PAGE. 

Note of Transmittal iii 

Membership of the Board iv 

Motto vi 

Introductory vii 

Secretarj'"s Report 1 

Meetings of the Board 2 

Sanitary Legislation 2 

The New Public Health Act 9 

Diphtheria at Allen's Corner, Deering 15 

Diphtheria in East Madison 18 

Dii)htheria in Canton 21 

Diphtheria and Other Diseases in Brunswick 24 

Typhoid Fever in Van Buren 31 

Typhoid Fever in Other Towns 33 

Nuisance in Deering 36 

Visit to Norway 37 

Visits to Other'Towns 39 

Circular on Contagious Diseases of Animals 40 

Treatment of the Drowned 53 

Library 56 

Expenses of the Board 66 

Reports from Medical Correspondents 67 

Special Papers 137 

Various Sanitary Topics. By tlie Secretary 137 

Contagiousness of Consumption 137 

Sanitary Significance of Mild Cases of the Infectious Dis- 
eases 144 

Comparative Value of Negative Evidence as to the Non- 
Contagiousness of Diseases 148 

Notes on Disinfectants 151 

Cheese, Milk and Ice Cream Poisoning 163 

Other Kinds of Poisoning 167 

Ptomaines and Leucomaines 168 

Garbage Furnaces 171 

National Conference of State Boards of Health. 

By E. C. Jordan, C. E., Member of the Board ISO 

Water Supply, Public and Domestic. 

By J. O. Webster, M. D., Member of the Board 107 

Bovine Tuberculosis. By the Secretary 219 

Comparative View of Sanitary Laws. By the Secretary 261 

Healthful School-Rooms. 

By J. O. Webster, M. D., Member of the Board 273 

Summer Resorts. By the Secretary 283 

Glossary 286 

Index 2S9 



"The gi'eat question of the day is not this operation or that, not 
ovariotomy or lithotomy, or hip- joint amputation, which have reflected 
so much glory upon American medicine — but preventive medicine, the 
hygiene of our persons, our dwellings, our streets — in a word, our 
surroundings, whatever or wherever they may be, whether in city, 
town, hamlet, or country ; and the establishment of efficient town 
and State boards of health, through whose agency we shall be more 
able to prevent the origin and fatal effects of what are known as the 
zymotic or preventable diseases, which carry so much woe and sorrow 
into our families, and often sweep like hurricanes over the earth, 
destroying millions of human lives in an incredibly short time. The 
day has arrived when the people must be aroused to a deeper and 
more earnest sense of the people's welfare, and suitable measures 
adopted for the protection, as well as for the better development of 
their physical, moral and intellectual powers. This is the great 
problem of the day ; the question which you, as representatives of 
the rising generation of physicians, should urge, in season and out 
of season, upon the attention of 3'our fellow-citizens, the question 
which above and beyond all others should engage your most serious 
thoughts and elicit your most earnest co-operation. "When this great 
object shall be attained, when man shall be able to prevent disease, 
and to reach with little or no suffering his three-score years and ten, 
so graphically described by the Psalmist, then, and not till then, will 
the world be a paradise." 

Prof. S. D. Gross. 



INTRODUCTORY. 



The State Board of Health of Maine has been organized less than 
two years. In this, the second year of its work, it has had to cope 
with no great epidemic nor with the near danger of one. Reports from 
the various parts of the State show that the general health of the 
Commonwealth has probabl}^ been somewhat better than that of the 
average year. This fact, that we are not threatened with immediate 
danger from any imported epidemic, would argue in the minds of some 
that there is no present need of sanitary work or of sanitary organi- 
zations. State or local. But to briefly finish the sanitary chronicle for 
the year it must be said that there have been somewhat frequent out- 
breaks of our indigenous infectious diseases ; and it is exactly from 
these well-known maladies that our mortalit}^ lists are often swelled 
to too large proportions. Thus we read in the local records of diph- 
theria as it has prevailed in the State for the past twenty-five years 
or more that "the epidemic of 1860 was a fearful one. It swept oflf 
whole families of children and even depopulated school districts ;" 
that "over one hundred deaths occurred in the small town of Lee in 
six months ;" that in 1862, one physician treated eight hundred 
cases of diphtheria and says he has probably treated three thousand in 
all ; that in 1878 in a small school district a family of five children were 
attacked with diphtheria and four died, and that the neighbors repre- 
senting eight families assisted in nursing these children and carried 
the disease to their families in every instance except one ; that on 
account of this disease in 1886, in a small village, eight families were 
thrown into mourning within a few weeks. 

If possibl}' cholera and small-pox in this State or in this countr}' 
can be said to slay their thousands they are outdone in destructive 
prowess, as was Saul by David, in that the every-da}' diseases slay 
their tens of thousands. And this goes on under the protest of those 
who know how unnecessary much of this is. To know that a given 



Vlll INTRODUCTORr. 

disease is a contagious disease is to know that it is a preventable 
disease. This fact should be clearlj* appreciated b}- the people and 
ought to shape their actions in reference to guarding against the dan- 
ger of these diseases. 

Man}- years ago Lord Palraerston gave the following rather start- 
ling answer to his Scotch petitioners who were asking for a day of 
fasting and prayer to protect them from the pestilence : "Go home, 
and see that your towns and cities are freed from those causes and 
sources of contagion which, if allowed to remain, will breed pesti- 
lence and be fruitful in death in spite of all the prayers of a united 
but inactive people !" This good advice was probably given in no 
irreligious spirit, but in accordance with sound sense and an under- 
standing of the main requirements in the case. It was given too, 
knowing that the word "epidemic" has lost or is fast losing the orig- 
inal signification which it had by virtue of its derivation, and does 
not mean a disease which has come down from above or from the atmos- 
phere upon the people, but is now usuall}^ used as referring to one 
which, with infectious qualities, has escaped from the premises or local- 
ity in which it first appeared and has spread upon the communit}' or to 
other communities, almost alwa3's b}' means of the hundreds of ways 
which social intercourse and traffic make possible. To aid us in doing 
our duty in this direction we should clearly comprehend that the 
epidemic ma}' be compared to the fire which swept away our town of 
Eastport and which like all fires was a small flame at first which a 
bucket of water might have extinguished. The epidemic grows in 
the same waj- from small beginnings which in many cases might have 
been confined to the primary cases if a little intelligent care had been 
taken to destroy the contagion and not let it develop its tendency to 
wander. The Utopia of the hopeful sanitarian is a place where the 
people will demand that every spark of the contagion of the danger- 
ous infectious diseases be treated as promptly and as eflfectually as 
are the beginnings of conflagrations in our cities that have the best 
organized fire departments. 

Is this practicable, or only visionary? 

Dr. Budd of Bristol, England, who died a few years ago, after a 
large and extended experience as a ph3'sician and hygienist, was able 
to say of scarlatina that "For a period of nearly twenty years, dur- 
ing which I have been employed in a very wide field, I have never 
known the disease to spread in a single instance beyond the sick-room, 
and in a very few instances within it," The rules which he laid down to 



INTRODUCTORY. IX 

accomplish so favorable a result with a disease so infectious were few 
and simple, but imperative. The}' were essentially the same as those 
which are now generally employed by local authorities in all parts of 
the world and by means of wliich they meet with an amount of suc- 
cess commensurate with the wisdom of the laws, the etlicieney of the 
local officers, and the intelligent co-operation of tlie people at large. 
For instance, as regards the success of the local health officers in 
Michigan in restricting outbreaks of diphtheria, the following is 
quoted from the last report of the Secretary of the State Board of 
Health of Michigan. 

''Fifteen health officers, who reported on the special final report 
blank that patients had been isolated and that bouses had been dis- 
infected, reported that the outbreaks had been limited to one case. 
Nineteen others reported on the final report blank that the success 
of measures taken to restrict the spread of the disease had been 
'good;' four stated that they had met with 'perfect' success; eight 
reported that they had been 'successful' in restricting the spread of 
the disease. Measures taken to restrict the spread of diphtheria in 
other cases were reported to have met witli the following success : 
'So far complete,' 'all that could be desired,' 'remarkably effec- 
tive,' 'excellent,' 'confined to one family ;' 'restricted to one 
house,' 'confining the spread of the disease to the two cases named,' 
'that no new cases have come down with the disease although there 
were others in the house all through,' 'no new cases appeared after I 
was notified.' " 

In a late communication on the practica1)ility of restricting diph- 
theria and the success which has followed efforts in his State, Dr. 
Baker, the Secretary of the same Board, says : 

"In the 102 outbreaks where isolation or disinfection or both wore 
neglected, the average cases per outl)reak were a little over 16, and 
the average deaths were 3.23 ; while in the IIG outbreaks in which 
isolation and disinfection were both enforced, the average cases per 
outl)reak were 2. 80 and the average deaths were .00 ; indicating a 
saving of over 13 cases and 2.57 deaths per outbreak, or 1,545 cases 
and 29S deaths during the year, by isolation and disinfection in the 
110 outl)reaks, compared witli those in which little or nothing was 
done." 

Testimony of tliis kind miglit be adduced in abundance. It assures 
us that tlie measure of success which we sliuU attain in tlie restriction 
of the contagious diseases will Ix^ limited only by the inadequacy of 



X INTRODUCTORY. 

the means and methods which we may bring to bear upon them. It 
should also be a forcilile reminder that, with us, the great desideratum 
is a thorough sanitary organization, branches of which shall extend 
into every city, village and township to promptly take cognizance of 
cases of the dangerous contagious diseases, and as far as is possible 
by approved metliods to stand ready to aid the afllicted household and 
to guard the public from unnecessary dangers. This "consummation 
devoutly to l)e wished" seems at the time of writing this to be in a 
fair way of a speedy fultilmeut. When it is an established fact the 
good results which will surely but gradually follow will be appreciated 
by the general public, and the c.onlid(nice in the good old State of 
Maine will rise both in the mind of her own chihlren and in that of 
the outside world. 



SECRETARY'S REPORT. 



As Secretary ajid Executive Officer of the Board, I have tlie honor 
to present the following, my second annual report, for the year end- 
ing Dec. 31, 1886. It will inckide only snch parts of the proceed- 
ings at the meetings of the lioard and of its woik, and of the work 
of the Secretary, as may be thought to be of interest to the general 
public, or of use in teaching and impressing ceitain things which 
ought to be learned. 

During the year, no change, either in the membership or in the 
officers of the Board has been made. At the annual meeting held 
in March, Dr. Frederic H. Gerrish was re-elected President. Dr 
J. 0. Webster, whose term of membership expired January 31, 
1886, was re-appointed by the Governor to fill the vacancy thus 
occasioned. 

The names and addresses of the members of the Board, with the 
dates at which their terms of office will expire, are as follows : 

E. C. Jordan, C. E., Portland, term expires January ;^1, 1887. 

O. A. Hour, M. D., Lewiston, term expires January 31, 1888. 

Hon. Stephen J. Young, Brunswick, term expires January 31, 
1889. 

Hon. Lewis Barker, Bangor, term expires January 31, 1800. 

Frederick H. Gerrish, M. D., Portland, term expires Janu- 
ary 31, 1891. 

J. O. Wk:i?stkk, M. D., Augusta, term expires January 31, 
1892. 

One member, the Hon. Stephen J. Young, is now in Germany, 
whither he went in the autumn for a somewhat prolonged stay. 
Another member, Dr. O. A. Horr, has recently returned from 
Europe after an absence of six months. 



2 STATE BOARD OF HEALTH — SECRETARY 8 REPORT. 

Meetings of the Board have been held as follows : 
The annual meeting on March 29, 1886 ; the second quarterly 
meeting June 29, 1886 ; the third quarterlj' meeting September 27, 
1886 ; an adjourned meeting October 2.5, 1886 ; an adjourned meet- 
ing November 29, 1886 ; the last quarterly meeting December 27, 
1886. 



At the annual meeting in March the following committees were 
appointed for the ensuing year : 
On Finance — The Hon. Lewis Harker, Hon. S. J Young, and the 

Secretary. 
On Disposal of Excreta — F. H. Gerrisli, M D. 
On Ventilation— 0. A. Horr, M. D. 
On Summer Resorts — Hon. S. J. Young. 
On Sewerage and Drainage — K. C Jordan, C. E. 
On Water and Water Pollution— J. O. Webster. M. D. 
On School Houses and School Hygiene — A. G. Young, M. D. 



SANITARY LEGISLATION. 

From the very first the Board could not fail to be aware of the 
defective condition of our existing pul)lic health laws and to fcol the 
need of improvement in tiiem. In seeking to guard the State 
against the danger of tlic importation of small-pox, which so strong- 
ly threatened it during our first year's work, the very unsatisfactory 
condition of our sanitarv legislation, as compared with that of some of 
the other States, was painfidly felt, and no less has the need of better, 
more modern laws been felt for the prevention of those diseases 
which prevail, wluither it is an epidemic, year or not, in some |)art8 
of onr State, the year in and the year out. 

The law establishing the State Boar.l of Health provides that it 
shall make "such suggestions as to legislative action as they may deem 
necessary.' That we might do this part of our duty in such a way 
as woidd 1k! for the best interests of the State, a careful and extended 
study has b(!en made of the public luialtli laws of the other states 
and of other countries, and of tiie working of those laws, particidarly 
of those of the English-speaking p(!oj)l(!H. As the result of thi& 



SANITARY LEGISLATION. 3 

examination and of several meetings of the Board whicli were 
devoted almost wholly to this single topio, the draft of a hill entitled, 
" An Act to establish Local Boards of Health and to protect the 
People of this State from Contagious Diseases," Is presented further 
on in this report. It embodies the views of the Board in regard to 
what is needed by the State in those directions in whicli there .seems 
to be the most urgent need of amendment and reform, to wit, in the 
direction of providing for a more effective local sanitary government 
by establishing local boards of health, specifying their powers and 
duties, and providing for the control of contagious diseases. That 
the reasons why these suggestions for legislation are made may be 
understood, and that the need of the pro[)>)sed changes may be appre- 
ciated, the remarks on the next- few following pages are submitted. 

Hitherto, until within comparatively recent 3'ears, most of the 
health Saws of the world have been made in the face of some great 
impending danger. The fear of the approaching pestilence has more 
frequently been the inspiration of the sanitary law-maker. In the 
reign of James I., one hundred years before the last terrible sweep 
of the plague, and the London holocaust which, so it seemed, there 
and then forever put an end to its ravages, we may find a sample of 
such sanitary legislation. 

"If any infected person, as aforesaid, so commanded to keep 
house, shall contrary to such commandment willfully and contemptu- 
ously go abroad, and shall converse in company, having any infec- 
tious sore upon him uncured, that then such person and persons 
shall be taken, deemed and adjudged as a felon and to suflcr the pains 
of death, as in case of felon\'. 

— Anno primo Jacohi Regis." 

The short act of wliich this is the most important part, was almost 
all of the sanitary legislation which was done in the British Parlia- 
ment for three or four centuries. It sought to guard the well from the 
danger of infection by immuring the unfortunate victim of the plague 
within the walls of the abode whose emanations had largely to do 
with the production of the disease. The scores of details which go to 
make up the whole of healthy living, and whose neglect are the chief 
factors in the causation of disease, or at least of those infectious and 
epidemic diseases whose unusual prevalence has constituted the his- 
toric plagues, were wholly ignored in those early times, a matter of 
no surprise when we recollect the almost entire absence of knowledge 
which then prevailed respecting the causes of diseases. 



4 STATE BOARO OF HEALTH — SECRETARY S REPORT. 

Later, but not far from the time when the phigue ceased to ravage 
the English coasts, another pestilence, sniall-pox, arose, or rather was 
imported, and its presence is recorded in a few, hut in oidy a very few 
parliamentary acts. For centuries these two pestilential diseases 
dominated the scanty sanitary legislation which was enacted, and 
even long after the one had become a disease of the past, and the 
nieans of etFectually c):nri)lliug thi othjr hid bjeu placi^d in our 
hands so that the t»wn whicli suffered severely from it could only be 
said to be expiating its .sin of neglect, the dread and the renicmhrance 
of these two plagues still shaped oar laws. In the legislative bodies 
of the early American Ctdoiiies tliere were passed somi> health laws 
which, considering the date of their enactment and the undeveloped 
condition of sanitary science in those times, are a credit to our early 
legislators. These early colonial laws formed the I)asis of the health 
laws of most of the States, and as such many of them may now be 
found on our statutes almost unchanged. Of these ancdeut health 
laws it may be said that some of the sections of them are still of tlie 
highest worth, while other sections might perhaps keep their place 
on account of historic associations, but hardly for any useful purposes 
which tUey now serve. 

In the legislatures of many of the States, particidarlv in those 
which were the first to establish State boards of health, there have, 
within the last ten or fifteen years, been pas.sed many new enactments 
relating to iiealth matters. Thene new laws are generally far more 
useful than the older laws, for the reason that they are founded on a 
careful consideration of the present wants of sanitation and in the 
light of a hygienic knowledge which has beer, carried forward to a 
much more advanced stage. In our own State, however, health legis- 
lation, in thojMi directions in which such acts may do the greatest 
good, has virtually been stationary for generations, and many of those 
provisions are entircdy wanting whirli sire essential to the securing of 
an cquital)le adjustment of many of those sanitary relations winch 
our social proximities entail. The practical workings of .sn(di law.s 
as ours cannot fnil to be liigldy unsatisfactory, since thi^y were framed 
to meet [)art4cularly the danger from tiiose pests whicli ])reviiii now 
ttt rare intervals or not at ail, instead of to meet the danger of those 
diseases which arc; now actually causing omv too large mortalities. 

A somewhat (h-tailed examination of our prcsiuit law and a com- 
pari.son of it with some of the points in other public health codes 
will show th(! justice of these strictures. 



SANITARY LEGISLATIOX. 5 

Our provi.sioiis for local saiiiiiiry o;overiimeiit form sm auomaly 
among the other statutory acts for the same purpose. 

"A town at its annual nieetin;^. may choose a health commiltee of 
not less than three nor more than nine, or one person to be a health 
officer; who at the expense of their town shall remove all Kith found 
in any place therein, which in their judgment endangers the life or 
health of any inhabitant ; and may require the owner or occupant, 
when they think necessary, to remove or discontinue any drain or 
other source of filth." 

The restriction of the choosing of the health committee to the 
annual meeting is not prudent ; for exigencies are likel3" to arise at 
any time^ and have been observed by the Board this past year, in 
which it is highly desirable and necessary that a special meeting be 
called and a health organization of some kind be immediately eHected, 
either by the choice of a health conimittee or a board of health. 

It will be noticed that it is optional with the towns to choose either a 
health committee or a health officer, and that their specified duties are 
identical and very limited, being, in fact, confined to the removal of filth, 
or in other words restricted to the duties of the scavenger. This 
as.«ignment of powers and duties of the health officer is unique and 
not to lie found elsewhere in the United States. Usually the health 
officer is the executive officer of the local sanitary authority perform- 
ing his duties under the general direction of the local board : in some 
of the States being himself a member of the Board and in others not. 
In either case the full board constitutes a board of appeal from the 
acts and decisions of the health ofiicer, and exercises a restraining 
influence over any possible vagaries of that official. 

'• If any town, at its annual meeting, omits to choose such com- 
mittee or officer, the municipal officers shnll be a health committee 
and have all the powers and perform all their duties." 

" A town may choose a board of health of not less than three nor 
more than nine persons, who shall have all the powers and be subject 
to all the duties, restrictions, liabililies and penalties of the municipal 
officers, and of the health committee or officer." 

Thus it may be noticed that a multiplicity of choices is open to the 
towns — a health committee, a health officer, the municipal officers as 
an ex-officio health committee, or a board of health. This abundance 
of resources, as the result of legislation at various times, has been a 
source of perplexity and misundeistanding for the towns. The dis- 
tinction between the duties and powers of the health committee or 
health officer and the board of health has not usually been kept in 



6 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

view, and the one or the other has been chosen, according aa the 
ruling spirit of the town meeting took a fancy to the one or the other 
of what very often have been considered aa elective synonymes. 
Whether the one or the other be chosen is very far from being a 
question of no moment. The powers and duties of the board of 
health are far more ample than are those of the health committee. 
Within the jurisdiction of the former fall a score or more of ques- 
tions of the greatest importance in the preventing or staying of 
diseases, particularly the contagious diseases, which tlie health com- 
mittee can*have nothing to do with. 

The terms health committee and health othcer, as defined in our law, 
are useless, and 3uch ofhees with tlioir present limitations of functions 
should be abolished, and the liealth authority inhere in the health board 
or in the municipal officers as an ex-officio board. It is generally admit- 
ted, however, that better work and better results may be secured witli 
an independent board than with an ex-officio board, and in several 
instances States have enacted that in no case shall any member of the 
board be connected with the municipal government. It is important 
that the health officials should be persons who are interested in sani- 
tary work. No part of local government is more important tlian the 
sanitary management of the town, and unless the board in whom the 
town intrusts the supervision of its health interests is alive to the 
value of such work, but little will be done. The municipal officers 
are usually ^men who have been chosen for their qualifications in other 
directions, rather than for their fitness as custodians of tlic public 
health ; consequently they do their work in those directions in which 
they feel assured they are the most competent to act, regarding their 
ex-officio position as health officials when the force of circumstances 
throws it upon their attention, as only a troublesome deviation from 
their legitimate sphere. To have tolerably good work done it is 
essential that the board be acquainted with the modern methods of 
dealing with the many questions which are now coming up for the 
consideration of such bodies, for instance, house drainage, whether in 
the country or in the city; economical and efficient ventilation, partic- 
ularly of dwellings and school-houses; water supply and the most 
frequent sources and dangers of its pollution ; the peculiarities of the 
contagia of our prevailing infectious diseases and the proper methods 
to be employed for the destruction of these contagious principles ; 
the methods of managing endemic and epidemic diseases and especially 
the prompt care of the; primary cases, thereby avoiding the occurrence 



SANITARY LEGISLATION. 7 

of the epidemic. That tlicsc ami the many oIIkt vital qiicstiotis, 
some or all of wliicli are always before every r.oininunity, great or 
small, for solution, shall receive fitting treatment, it is better that 
boards of lieallh have, when possible, at least one physician on the 
board, and that the term of office of the members be for more than a 
single year. 

As regards the question of election of the board by the town or its 
ap[)ointment by the municipal oflicers, the practice in nearly all the 
States is to have it appointed Ijy tlie municipal otficers. The advan- 
tages are vastly in favor of this latter method, in that political parti- 
sanship is to a consi(leral)le extent eliminated from the choice and in 
that a wise discrimination is mor<! likely lo l)e exercised in the 
selection. 

If we in this State are to have decent local sanitary government, 
such as obtains in many of our neighboring States, and such protec- 
tion to life and health as the State owes to her people, and such as onr 
summer visitors have a right to expect, we must have a permanent 
sanitary organization in every town. This is indispensable. No 
health bodv or<ra'ii'/;<Ml in the face of an impending epidemic or in its 
midst can cope su(^"cssfully with such a danger, to say nothing of the 
more important work of staying the hand of the destroyer which 
come.s in the shajjc of those indigenous diseases, as we might term 
them, which are always within our borders. 

Our law dealing with the matter of contagious diseases has a few 
good features too valuable to be lost in any future attempts in the 
direction of the amendment or codification of our sanitary legislation ; 
but most of it, as has been remarked, is better adapted to the public 
needs and to epidemiological conditions as they existed many years 
ago rather than tn our present wants and to the present phases of 
diseases. We have provisions for the issuing of a writ lor the pur- 
pose of ejecting an inlecied tramp from our State in a neighI)orly way 
back again into tlie State whence he came, and if our neighboring 
comnmnwealth have a similar legal provision, everything would be 
complete whereby to give the citizens of the two States the full benefit 
of this infected shuttlecock. We have also provisions for the securijig 
of infected persons and goods and the care of them, but we have no 
legislative declaration of what diseases shall be deemeil contagious 
so that there may be no doulit or hesitation with health officials in 
doing their duty. Neither have we any distinct legislative provi- 
sions for the disinfection of persons, rooms, clothing and other things 



8 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

which have been subjected to the iufectiou of dangerous contagious 
diseases, a matter of prime importance without which there can never 
be any assuranee that a focus of infection will be stamped out or 
destroyed. Nor liave we any sutficient statutory law restricting com- 
munication with the sick ; nor forbidding tlie removal of persons and 
clothing and things from one house to another, unless permission be 
granted by the board of health or physician ; nor regulating the 
behavior of nurses and other attendants in view of lessening the 
danger of spreading these diseases ; nor any statutory guaranty that 
convalescents may not spread sucli diseases at will before the danger- 
ous period has passed. There ought to be a strict prohibition of 
public funerals of those who have died of certain dangerous conta- 
gious diseases, or at least the statutes should distinctly state that 
boards of health sliall have power to specify from what diseases 
deaths shall not be followed by a public funeral. In want of such a 
law strictly enforced, a malignant outbreak of diphtheria destroyed 
several lives last spring and seriously threatened to ruin the business, 
for this year at least, at one of our principal summer resorts. We 
ought to have, but have not, a law prohibiting the entrance by infected 
persons into public conveyances without notice to the driver ol the 
fact of infection, nor have we any provision for the disinfection of 
such conveyances after they are infected. An infected public hack, 
for instance, may be a veritable death trap for succeeding occupants^ 
and considering the small trouble of disinfecting should not be toler- 
ated for a moment. Infected clothing should not be permitted to be 
sold, lent or given away, until disinfected and rendered harmless. 
For want ot legal prohibition, and a local board of health to enfoi-ce 
it, a serious and very fatal outbreak of diphtheria has oi;curred this 
past year in Deeriiig. 

Bedding whicli cannot be disinfected should be l)urned and compen- 
sation given by the town. Our law should say, but does not, that 
infected houses shall not be let nor offered for rental until they arc 
disinfected. 

All the disinfection which has been mentioiu;d .sliould lie done 
under the direction and to tiic satisfaction of the I(K"al health authority, 
for much which is called disinfection is a delusion and a snare, lead- 
ing to tiie belief that safety has been secured when it has not in fact. 

Tlier(! HJiould be some provision to protect the public from the dan- 
ger of improper burial, disinterment and trarjsportation of bodies 
after death from certain infectious diseases. 



SANITARY LEGISLATION. 9 

All these matters which our statutory hiw wholly ignores, or 
provides for in no direct and satisfactory way, have been the subject 
of careful legislative consideration iu many other Stales and govern- 
ments, and the acts resulting therefrom have been highly satisfactory 
to the health authorities and to tlie people at large. 



NorK. — On account of the late date of publication of this leport 
we are enabled to say that, tlirongh the act of the Legislature which 
has but lately adjourned, most of the defects in our public health 
laws, pointed out in the above, no longer exist. Instead of the bill 
which was drafted by the Board, we have the pleasure of presenting 
to the people of our State the Ajllowing act, which is a slight modi- 
fication in some points of the original bill. 



An Act to estal)lish Local Boards of Health, and to protect the people 
of this State from Contajjious Diseases. 



Be it enacted by the Semite and House of Representatives in Legis- 
lature assembled, as follows : 

Sect. 1. There shall be a local board of health iu each city and 
town in this State to be composed of three members, anything in the 
charter of such city to the contrary notwithstanding. 

SiccT. 2. Their appointment shall be as follows : On the second 
Monday in April, one thousand eight hundred and eighty-seven, the 
municipal officers in each town shall appoint three persons, one (or 
three years, one for two ^cars, and one for one year, and thereafter 
annually before the loth day of April one person to serve three years, 
and each to hold office until another is appointed in his stead. Any 
vacancy arising from any cause shall be tilled at the first meeting 
thereafter of tlie municipal officers. If for any reason the appoint- 
ments are not made at said dates, the same shall be made as soon as 
may be thereafter. 

Skct. ',]. Before the fifteenth day of May in each y<-ar the board 
of health shall meet foi' the transactioD of business and shall choose 
a chairman ami a secretary from their number. 



10 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

Sect. 4. The chairmau shall preside at all meetia_s^s of the board. 
The secretary shall in a book kept for that purpose make and keep a 
record of all the proceedings at the meetings and of all transactions, 
doings, orders and regulations of the board of health. The secretary 
shall be also the executive officer of the board when a health officer is 
not appointed. 

Sect. o. The municipal officers may appoint a health officer who 
shall be a well-educated physician, who shall be the sanitary adviser 
and executive officer of the board, and who shall hold office during 
the pleasure of the board. The municipal officers shall establish his 
salary or other compensation and sliall regulate and audit all fees and 
charges of persons employed by each board of health in the execution 
of the health laws and of their regulations 

Sect. 6. It shall be the duty of the health officer, or where there 
is no health officer appoiuted, of the secretary of each local board of 
health, at least once in each year, to report to the State Board of 
Health their proceedings, and such other facts required, on blanks, 
and ill accordance witli instructions received from said board. He 
shall also make special reports whenever required to do so by the 
State Hoard of Health. He shall, within one week following their 
meeting and election of officers, report to the Secretary of the Stats 
Board of Health the name and address of each member of the local 
board, of the chairman and secretary, and of the health officer when 
one is appointed. 

Sect. 7. Each local board of health constituted under this iu:t 
shall liave power and it shall be its duty : 

I. To hold regular quarterly meetings, and special uieetings when- 
ever considered necessary by its executive officer, also whenever r»!- 
quested by the State Board of Health, or the president and secretary 
thereof. 

II. To prescribe the powers and duties of the local health officer, 
when there is one, and to direct him from time to time in the per- 
formance of his duties. 

HI. To guard against the introdiK^tion of contagi<Mis and infectious 
diseases, by the exercise of proper and vigilant medical inspection and 
control of all persons and things coming within the limits of its juris- 
diction from infected places, or which for any cause, are liable to 
communicate contagion ; to give public notice of infected places, by 
displaying red flags or bj' posting placards on the entrances of the 
prcmi-sea ; to require the isolation of all persons and things that are 



ACT OF THE LEGISLATUKE. 11 

•infected with, or have been exposed to, coutagioud or infectious dis- 
eases, and to provide suitable places for the reception of the same ; 
and to furnish medical treatment and care for persons sick with such 
diseases who cannot otherwise be provided for ; to prohibit and pre- 
vent all intercourse and communication with, or use of, infected prem- 
ises, places and things and to require, and, if necessary, to provide 
the means for the thorough cleansing and disinfection of the same 
before general intercourse therewith, or use thereof, shall be allowed. 
And it shall be its duty to report to the State Hoard of Health 
promptly facts which relate to infectious and epidemic diseases, and 
every case of small-pox, varioloid, diphtheria, and scarlet fever, oc- 
curring within the limits of its jurisdiction. 

IV. To receive and examine into the nature of complaints made by 
any of the inhabitants concerning nuisances dangerous to life and 
health within the limits of its jurisdiction ; to enter upon or within 
any place or premises where nuisances or conditions dangerous to life 
and health are known or believed to exist, and personally or by ap- 
pointed agents to inspect Jind examine the same ; and all owners, 
agents and occupants shall permit such sanitary examinations ; and 
every such board of health shall have power, and it shall be its duty, 
to order the suppression and removal of nuisances and conditions 
detrimental to life ami health found to exist within the limits of its 
jurisdiction. 

V. To make, alter or amend sucli orders and by-laws as they shall 
think necessary and proper for the preservation of life and health and 
the successful operation of the health laws- of the State, sul)ject to the 
approval of any justice of the supreme judicial court. Notice shall 
be given by the board of health of all by-laws made or amended by 
them by publishing the same in some newspaper, if there is one pub- 
lished in such town, if there is none, then in the nearest newspaper 
published in the county, and a record of such publication of said 
orders and b3-laws in the office of the town clerk shall l)e deemed a 
legal notice to all persons. 

Sect. 8. Where any local boanl of health is of opinion that the 
<;leansing and disinfecting of any house, building, car, vessel or vehi- 
cle, or any part thereof, and of any article therein likely to contaia 
infection, would tend to prevent or check infectious disease, it shall 
be the duty of such local hoard of health to give notice in writing to 
the owner, agent, or occupier of such house, building, car, vessel or 
vehicle, or part thereof, requiring him to cleanse and disinfect to the 



12 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

satisfiiction of the health officer, or board of health, such house, build- 
ing, car, vessel or vehicle, aud said articles within a time specified in 
such notice. 

Sect. 9. If the per'^on to whom notice is j^iven fails to comply 
th(M'o\vith, he shall be liable to a penalty of not less than five dollars 
and not exceeding ten dollars for every day during which he continues- 
to make default ; and the local board of health shall cause such house, 
building, car. vessel or vehicle, or any part tliereof, and articles to- 
be cleansed and disinfected at the expense of the town, and the town 
may recover the expenses so incurred from the owner, agent, or oc^ 
cupier in default, by act of special assumpsit. 

Sect. 10. Wiienever any householder knows or has reason to be- 
lieve that any person within his family or household has small-pox, 
diphtheria, scarlet fever, cholera, typhus or typhoid fever, he shall' 
within twenty-four hours give notice thereof to the health officer of 
the town in which he resides, and such notice shall be given either at 
the office of the health officer or by a communication addressed to him; 
and duly mailed within the time above specified, and in case there i3- 
no health officer, to the secretary of the local board of health either- 
at his office or by communication as aforesaid. 

Sect. 11. No householder in whose dwelling there occurs any of 
the above-mentioned diseases, shall permit any person suffering from 
any such disease, or any clothing or other property to be removed 
from his house, without the consent of the board, or of the health 
officer, or attending physician, and the said board, or health officer, 
or attending physician, shall prescribe the conditions of removal. 

Sect. 12. No parent, guardian, or other person, shall carelessly 
carry about children or others affected with infectious diseases, or 
knowingly or wilfully introduce infectious persons into other persons' 
houses, or permit such children under his care, to attend any school, 
theatre, church or any public place. 

Sect. 13. Wlienevcr any physician knows or has reason to be- 
lieve that any person whom he is called upon to visit is infected with 
small-pox, scarlet fever, diphtheria, typhus or ty|)hoid fever, or chol- 
era, such physician shall within twenty-four lioiu's give notice thereof 
to the secretary of tlie local board of health, or the health officer of 
the town in which such person lives. 

Si'XT. 14. No person affected with small-pox, scarlet fever, diph- 
theria, or cholera, and no person having access to any person affected 
with any of the said diseases shall mingle with the general public 



ACT OF THE LEGISLATURE. 13 

until such sanitary precautious as luay be prescribed by the local board 
or attending physician shall have been complied with. 

Sect. 15. Persons recovering from small-pox, scarlet fever, diph- 
theria, or cholera, and nurses who have been in attendance on any 
person suffering from any such disease, shall not leave the premises 
till they have received from the attending physician, Ijoard of 
healtJi, or health officer, a certificate that they have taken such pre- 
•cautions, as to their persons, clothing, and all otlier things which llu'y 
propose bringing from the premises as are necessary t» insure the im- 
munity from infection of other persons with whom they may come in 
•contact, and no such person shall expose himself in any public place, 
shop, street, inn or public conveyance witliout having first adopted 
sucli precautions. 

Skct. 1G. Nurses and other attendants upon persons sick with 
small-pox, scarlet fever, diphtheria, or cholera, shall adopt for the 
■disinfection and disposal of excreta, and for the disinfection of uten- 
sils, bedding, clothing and other things which iiavc been exposed to 
infection, such measures as may be ordered in writing by the local 
boanl of health. 

Sect 17. No person shall give, lend, transmit, sell or expose 
any bedding, clothing or other article likely to convey any of the 
above diseases, without having first takeu such precautions as the 
local board of health may direct as necessary for removing all dauger 
of communicating any such disease to others. 

Sect. 18. Any local board of health may direct the destruction 
•of any bedding, clothintr, or other articles, which have been exposed 
to infection. 

Sect. 19. Whenever small-pox, diplitheria. scarlet fever, or other 
■contagious disease shall appear in a town or a school district it shall 
be the duty of the local board of health immediately to notify the 
teachers of the pul)lic schools in the neighborliood, of the fact, and it 
shall be the duty of all teachers and school officers wlien thus notified, 
or when otherwise they shall know or have good reason to believe 
thjit any such disease exists in any house in the neighborhood, to ex- 
clude from the school-house all children and other persons living in 
such infecled liouses or who have calle<l or visited at suith houses, 
until such time as the. local boartl of health (or attending phj'sician) 
shall certify that such duldreu or other persons may salely be read- 
mitted. 

Sect. 20. When persons from houses or [)laces which are infected 
with any of the diseases specified in section nineteen have euterod any 



14 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

school-room, or when, from any other cause, the school-room has^ 
probably become infected, it shall be the teacher's dut}' to dismiss the 
school, and notif\'^ the school officers and local board of health, and no 
school shall be again held in such school-room until the room has 
been disinfected to the satisfaction of the local board of health, and it 
shall be the duty of the scliool officers and board of health to have the 
room disinfected as soon as possible. 

Sect. 21. The board, when satisfied upon due examination that a 
cellar, room, tenement, or building in its town, occupied as a dwelling- 
place, has become, by reason of want of cleanliness, or other cause, 
unfit for such purpose, and a cause of sickness to the occupants or the 
public, may issue a notice in writing to such occupants, or the owner 
or his agent, or any of them, requiring the premises to be put into 
a proper condition as to cleanliness, or, if they see fit, requiring the 
occupants to quit the premises within such time as the board may 
deem reasonable. If the persons so notified, or any of them, neglect 
or refuse to comply with the terms of the notice, the board may cause 
the premises to be properly cleansed at the expense of the owner, or 
may close up the premises, and the same shall not be again occupied 
as a dwelling-place until put in a proper sanitary condition. If the 
owner thereafter occupies or knowingly permits the same to be occu- 
pied without putting the same in a proper sanitary condition, he shall 
forfeit not less than ten nor more than fifty dollars. 

Sect. 22. No person having small-pox, diphtheria, scarlet fever, 
cholera, or other disease dangerous to public health, shall enter, nor 
shall any person allow anyone under his charge who has any such 
disease to enter any conveyance without having previously notified the 
owner or person in charge of such conveyance of the fact of his hav- 
ing such disease. 

Sect. 23. The owner or person in cliarge of any such conveyance 
sliall not, after the entry of any person so infected 4nto iiis convey- 
ance, allow any other person to enter it without having sufficiently 
disinfected it under the direction of the local board of health or the 
supervision of the liealtli offi(ror. 

Sect. 2i. No person shall let or hire any house or room in a 
house in which small-pox, diphtheria, scarlet fever, cholera or typhoid 
fever has existed, without having caused tlie hou:-iO and the premises 
used in connection tluu-ewith to be disinfc(;ted to the satisfaction of 
the local board of health. 

Sect. 25. Any member of a local board of health, or any health 
officer or other person employed by the local board of health may, 



DIPHTHERIA AT ALLEN'S CORNER. 15 

when obstructed in tlie perfbnniince of his duty, call to his assistance 
any constable or other person he thinks fit, and it shall be the duty of 
every su(;h constable or person so called upon to render such assist- 
ance. 

Skct. 2(1 Any person who siiall wilfully violate any of the pro- 
visions of this act or of said rej^nlations and by-laws — the penalty for 
wiiich is not herein specitically provided for — and any person who 
shall wilfully interfere with any person or thing to prevent the execu- 
tion of the provisions of this act or of said regulations and by-laws, 
shall be guilty of a misdomeanor ; and upon conviction thereof shall be 
subject to a fine not more than fifty dollars, and judges of municipal 
and police courts, trial justices, shall have jurisdiction original and 
concurrent with the supreme judicial and superior courts of all 
offences under this act. 

Skct. 27. Sections fourteen, fifteen, thirty-two and thirty-four of 
chanter fourteen of the Revised Statutes and all acts and parts of acts 
inconsistent with this act are hereby repealed. All acts and parts of 
acts which read "health committee" are hereby amended so as to 
read 'local board of health', and said chapter fourteen, sections one 
to thirteen inclusive, and sections sixteen to twenty-nine, inclusive, 
arc hereby amended so as to make "•municipal officers" read 'local 
board of health.' 

Sect. 28. This act shall take effect on the second Monday in 
April, 1887. 

[Approved March IG, 1887.] 



DIPHTHERIA AT ALLEN'S CORNER, DEERING. 

Upon petition •from the inhabitants of Allen's Corner, Deering, I 
went to that [)lace June 21st to investi<iutc in regard to the cause of 
an outbreak of diphtheria. I learned that there had been but few 
cases of diphllu'ria in the town of Deering for years, and at Allen's 
Corner, no eases for several years, — careful enquiry could elicit no 
information of any antecedent cases to which the present outbreak 
could be referred as the source of its contagion, except one. The 
history of this and of the subsequvMit cases is as follows : 

In the fall of 1885, Mrs. A. went to Boston, Mass., on a visit and 
took her child with her. While in Boston her child sickened with 



16 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

■diphtheria and died. The mother returned to Allen's Corner soon 
alter the death of her child, bringing home the clothes of the little 
•one. After her return, Mrs. A. herself had a light attack of diph- 
theria, as I have been informed by the physician who attended her. 

Soon after the return of IMrs A , she was visited by Mrs. B., ac- 
companied b}' her eldest daughter Jennie. During this visit Mrs. A. 
gave the clothes of the recently deceased child to Mrs. B. for her 
■children In a few days diphtheria ai)peared in the B. family. All, 
six or seven in number, were sick, but all recovered. In four or five 
days after the visit, Jennie was taken sick at Mr. C.'s where she 
worked, and went home. 

In the C. family only one per.son, a lioy. had the disease. 

The next family with this disease was that of Mr. D. He lived 
near the B. family and in each house there was a little boy of seven 
years of age Tliese two little fellows •'chummed" together, and 
soon alter the recovery of the B. boy, he was over playing with the 
D. bo}-. The latter was the first to be attacked in this fourth house. 
All the members of this family, six or seven in number, were sick ; 
the father and the baby died. There were also in this family two 
boarders, Mr. E. and Mr. F., both young men. Both had the dis- 
■ease and after a severe sickness both recovered. 

During the sickness of Mr. F. he was visited bj' Miss G. She 
lived with her father alone, and during her attack of diphtheria, 
which soon followed, Mrs H., a neighbor, was out and in helping 
her. Mrs. H. had a rather mild form of the disease, and Miss I., 
a teacher, who was boarding with her, had a severe form of the 
disea.se. 

Again, from the D, family, we find the disease carried to the J. 
family. Two weeks aftir their sickness the children of the D. fam- 
ily were over to play with the J. children, A few days alter this the 
sickness of the J. children began. In this family, there were three 
children all of whom were sick and with them the mother. All re- 
covered. During the sickness of the J. family Miss K., a teacher, 
visited them and soon after began a term of school at Morrill's Cor- 
ner, but was oI»lig('(l to leave it in a few days and went to the J. 'a 
where she was sick with the rest of them with diphtheria. 

These cases occurred between September, 1885, and the early part 
of the following January. Tiiere was then a lull until spring. 

During the sicknes.s of the J. family, in the winter, a niece of Mrs. 
J.'b, who made it her home with them a part of the time, was away. 



DIPHTHERIA AT ALLEN's CORNER. 



17 



She returned in April and soon after the " spring cleaning" had an 
attack of what the neighbors supposed to be diphtheria. 

Diphtheria appeared in the L. family in Ma}'. The three chil- 
dren had the disease and all died. Tlie first one sick was attacked 
on the 23d. The other two were sick later and probably received 
the contagion at home. The one which was first sick had attended 
school until its sickness. The J. children and others that had been 
sick with diphtheria wei'e also attending school. 

At the time of the death of tlie first L. child, Mrs. M. and Mrs. 
N. aided the family in laying it out. Mrs. M., who was fift\--three 
years of age, was attacked in a few da^'s and died in three more. 
Mrs. N. had a light attack soon after helping the L. family. 

At the time of my visit there was a case in the family of Mr. O. 
which I was unable to connect with the other eases by the link of 
contagion. A few other mild cases occurred whose historj' I could 
not get. Making a schematic arrangement of these cases and fam- 
ilies we have the following to show how the contagion traveled : 



Mrs. A.^ 

B. family. ^^ 

C. family. 

D. family. 
Mr. E. 
Mr. F. 

Miss G. 

Mrs. H. 

Miss I. 

J. family. 

Miss K. 

Mrs. J.'s niece. 

L. family. 

Mrs. M. 

2 Mrs. N. 



1 



1 1 



1 ^ 



11 



18 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

From the time of my visit to Allen's Corner in June there were no 
other eases of diphtheria until November. On the last day of Au- 
gust a house was vacated by a family which is not included in the 
above history, but which had diphtheria in the winter or spring. 
Eaih' in September another family moved into this house. The five 
children and the father were attacked with diphtheria in November 
and four of the children died. Following the precautions which 
were taken b}- the neighborhood there have as 3'et been no other 
cases. 

DIPHTHERIA IN EAST MADISON. 

July 2d, I went to East Madison on account of an endemic of diph- 
theria which at that date had caused the death of seven persons in 
that village within a few weeks. There was also in the evening when 
I left, a man rapidi}^ sinking with the disease who died the next 
morning. 

East Madison is pleasantly situated on the east side of Madison 
Pond, and on a branch of the Wesserunset River which forms the 
outlet of the lake. The principal part of the village, where most 
of the cases of diphtheria occurred, is perhaps a quarter of a mile 
from the pond. Immediatel}^ in the village is the Wesserunset 
Woolen Mill and its mill-pond, and above, at the outlet of Madison 
Pond, is the dam which holds back the water in this larger pond. 
On the 24th of May this upper dam broke and flooded the village, 
washing down at the same time as the people think, considerable 
mud into the lower, or smaller pond. There was considerable testi- 
mony to show that since the breaking of the upper dam there had 
been more smell than usual coming from the little pond in the vil- 
lage, especially during the evening and night, for during the last 
few weeks the Corporation had been in the habit of shutting down 
the upper gate when the mill closed in the evening to save the water. 
As the result, the water became low in the pond during the night and 
the shores were more exposed, and tlie offensive smell became quite 
perceptible. 

Certain persons in the village were so thoroughly convinced that 
this was the sole cause of the outbreak that thc^^ could not accept 
any other factors in the causation. Further than what has been 
mentioned, the general sanitary condition of the village was like 
what can be found in most New England villages which have given 
no special attention to health matters. The objectionable accumu- 



DIPHTHERIA IN EAST MADISON. 19 

lative privy system was in vogue and generally badly neglected, as 
usual. Sink drainage was badly managed in many cases, and in one 
case passed dangerously near the well. In another case the well 
from which the water was said to be good, was so situated that it 
must necessarily receive the soakage from the stable and other out- 
buildings ; in another case a neighbor's stable and pig-pen were 
onl3' five feet from the dining-room window. 

These things are generally considered prejudiced to the health con- 
ditions of homes and villages, and rightl}' ; but in these outlireaks 
of diphtheria this Board has almost invariably found, in addition to 
any unsanitary conditions of premises or of towns, which might be 
present, the history of the propagation of the disease by contagion. 
The grounds for believing that the contagion may have been im- 
ported, and that its spread may have been largely due to infection 
are these : 

Just before the outbreak in East Madison there had been quite a 
prevalence of diphtheria in Skowhegan, and several deaths were 
attributed to that disease. Miss A. had been at work in a hotel in 
the latter place and came home sick with a sore throat. 

She was sick a week, but had no phj'sician to attend her. Two 
other children in this famil}' were sick in the same way, the second 
one being attacked just two weeks after Miss A.'s return from Skow- 
hegan. Tiieir mother told me that all three of the patients had 
quite a sore throat, had white patches, some of which were as large 
as a bean, and that they all subsequently, during their convales- 
cence, had paralysis of the throat, so that it caused some difficulty 
of speech and the return of lluids through the nose when swallow- 
'ing was attempted. 

Another young lad}-, iVfiss B., had been taking music lessons in 
Skowhcgan, making her last visit there two weeks before she be- 
came sick on the 1st of April. Mrs. B. said that she had quite a 
sore throat, white patches in the throat, and as a sequel, the nasal 
voice and return of fluids through the nose. Two other children in 
this family had the same sore throat in a short time after Miss B.'s 
sickness. 

Neither of these young ladies who had been in Skowhegan, was 
aware that she had been exposed to the contagion of diphtheria. 

Mrs. C, who was a near neighbor of the B.'s, helped to take care 
of the children while they were sick. She took the disease and died. 



20 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

Mrs. D., -who was also a near neighbor, helped at the laying out of 
Mrs. C. and was attacked in a few days and died after a sickness of 
only five da3-s. Her age was fifty-six. 

Miss E., fifteen years of age, who lived near the B famih', was the 
next ease. She died after a sickness of three weeks. Her mother 
thinks that she took the disease from the B. family, as she called 
there while the children were sick. 

In the famih' of Mr. F. a daughter had the disease and recovered. 

These cases which have been given occurred in April and Ma}'. 
During the month of June there were the following cases : 

At Mr. F.'s house auother case, that of a little boy who died. 

lu the G. family, two cases, one fatal. 

In the H. family, three cases, one fatal. 

Mr. I , a young man who sat up with the H. boy who died, had 
diphtheria in a few days after, but recovered. 

In the J. family, two cases, one fatal. The earlier of these two 
cases was the first case at the Lower Mills. It was in a bo}' twelve 
years of age, who had played with the children at the Upper Mills, 
and attended Sabbath school. He died June 12. 

Mrs. K., a neighbor at the Lower Mills, who had helped while 
the boy was sick, became sick June 17, but recovered. 

In the L. family, two cases, both recovering. 

H. M., a young man living just outside the village, recovered. 
He was in the habit of spending his evenings in the village stores. 

Mr. N., who was sick while I was in the village, died the next 
morning. 

Thus it will be seen that there occurred eight deaths in as many 
different families. All but one of these fatal cases occurred at the 
Upper Mills and not far from the suspected mill-pond. This fact 
served to strengthen the opinion, which was held by some, that the 
disease was due to the evil influence of the mill-pond. While it 
seems quite reasonable to believe that the offensiveness of the pond 
may have been an accessary, a predisposing cause, it must be borne 
in mind that, let the diphliieritic infection once be introduced into 
a sequestered village like the one under consideration, and, given 
the satne want of isolation of the sick and the same want of thor- 
ough disinfection, it is pretty sure to find victims, whether there is 
a mill-pond in the village or not, or whether the village is clean or 
filthy. While it is quite likely that the unsanitary conditions of 
this particular village played a bad part, it is very certain, as may be 



DIPHTHERIA IN CANTON. 21 

seen in the above account, that contagion played a principal part. 
It was not possible to trace out its course so completely and satis- 
factorily as in some of the other outbreaks of this year, for the 
reason that in many of tlie cases tliere were so many possil)le ways 
for its reception. In the village, there were several stores, and in 
these the mill hands and the other people of the v'llage were in the 
habit of congregating outside of working hours. In one of these 
stores, there was constantly a pail of iced water and a drinking-cup 
for the accommodation of the public, and on account of the hot 
weather which then prevailed this drinking-cup passed very frequently 
from mouth to mouth. Besides the cases of diptheria which have 
been enumerated, there were many eases of sore throat which were 
not considered diphtheritic, but which, froii) a hygienic point of 
view, it perhaps might have been safer, during an epidemic of 
diphtheria to regard as such. Adding still furtlier to the difliculty 
of tracing the course of the contagion from person to person, were 
the facts that many of the funerals following the diphtheria deaths 
were public, that the Sunday school was not closed, and that the 
village school was not closed until two weeks before my visit. 

Directions were given to the people in regard to what ought to be 
done, particularly emphasizing the need of strict i.solatiou of the sick, 
thorough disinfection, improving the sanitar}- condilion of ilie [)lace, 
and the abolition of the public drinking-cup from the store. It was 
further recommended that the}- should form a local voluntary sani- 
tary organization at once. These recommendations tiiey accepted 
and put into operation immediately. In some cases who'e the owner 
was not able to abate or remove nuisances, the neighbors turned out, 
and helped him to do it. In the case of the stable which was within 
five feet of a dining-room, they moved it back for the owner. The 
result of this activity in the right direction was that only one more 
case occurred, and that a relapse and re-appearance of diphtheritic 
symptoms two days after my visit, in one of the cases which has 
already been mentioned. 

DIPHTHERIA IN CANTON. 

July 8th I went to Canton at the request of Dr. Stanwood, chair- 
man of the local board of health. Diphtheria had broken out in 
Gilbertville, a village about a mile from the village of Canton. 

The first to suffer was the family of J. P. Three children were 
sick. The first case, three years old, was first seen by the medical 



22 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

attendant June 26. It then bad an eruption over the whole body 
which he called measles. On the third day there was sore throat fol- 
lowed by an extensive formation of diphtheritic false membrane. On 
the 27th another little one five years old had an eruption appearing 
with the characteristic blotches, and in six days more the throat 
trouble began. In this case there was also an extensive formation of 
false membrane. On the same date, also, the third one became sick. 
In this case the eruption was not so general in its distribution as in the 
others. It was confined mostly to the posterior aspect of the body 
and to the thighs. lu the first two cases the eruption appeared first 
on the forehead and followed the course of distribution which is usual 
in measles. In the youngest one there was but little cough, but there 
were the usual premonitory' symptoms of coryza. In the older ones 
there was a slight cough. 

In the family of J. D. a girl eleven j'ears of age became sick Avith 
diphtheria June 28. She was sick a week and died. There was no 
eruption in this case. 

In the family of J. J. a little boy four years old was attacked July 
3rd and died in three days. A girl five years old was taken Jul}'' 4th ; 
at the time of my visit she was still very sick. 

In the McL. family a little girl had recently been attacked, and 
in a French family there had been two cases. 

Tliis was the status of affairs at the time of ray visit. 

August 30th I was again called to Canton on account of the re-ap- 
pearance of diphtheria. There had been in this present lot eight 
cases and one death, which had occurred on tlie 28th. 

As regards the origin of the infection which started the outbreak 
of diphtheria in Canton nothing more satisfactory' than a basis of 
conjectures could be arrived at. The first family in which the dis- 
ease appeared had recently returned from a visit to New Hampshire, 
where measles had prevailed earlier in the season, and the children 
had come in contact with a child in the station at Mechanic Falls 
who had recently had measles. This on their return, however, was 
four weeks before their sickness. Further than this it was impossible 
to get any history which would point to the importation of the diph- 
theritic poison. Man}- facts that were gathered seemed to point to 
the school-house as the probable source of infection. The school- 
house was used Sundays as the place of meeting of the Catholic 
church, and there was the possibility that an unrecognized case of 
diphtheria hud been in the school-house so as to infect it. If, how- 



DIPHTHERIA IN CANTON. 23 

ever, we were to admit the possibility of the spontaneous origin of 
diphtheria and were to look to the school-house for its inception, this 
outbreak would very aptly fit into the category of outbreaks due to 
local unhygienic conditions. 

The school-house stands on a knoll around which on the west and 
north Whitne}' Brook loses itself in a boggy swamp. This swamp 
is not more than three or four rods from the school-house. On the 
west side of the school-house also is the priv}', not more than six 
feet from the school-house, the two windows of which were kept open 
during the hot weather which prevailed before the outbreak. The 
vaults were in a very unsatisfactory condition and the prevailing 
west wind carried their dangerous emanations in through the win- 
dows. On the south side of the school-house, not more than two or 
three rods distant, was a piece of ground a quarter of an acre or more 
in extent on which, in the spring, a large number of privy-vaults 
had been emptied and harrowed in, not plowed in. The rank, dark- 
green growth of grain on it showed how liberal had been the dressing. 

All the children who had been attacked at the time of my first 
visit had been attending school. The first case was seen by the 
doctor June 26, and school was not closed until July 2. The first 
child sick was only three years old but was attending the school 
until her sickness, and after this the other children from the same 
house attended until they were taken down. 

At the time of my first visit to Cautou I found that tlie local board 
of health had already begun vigorous measures in the way of clean- 
ing up aud abating or removing certain nuisances. Their efforts, 
however, to secure proper isolation of the sick and the disinfection of 
rooms and things which ought to be disinfected were not at all satis- 
factory to the State Board, nor had their success in this direction been 
satisfactory to lliemselves. This failure to keep the sick separated and 
isolated from the well was the most serious trouble, also, during the 
second outbreak ; and it was due mainly to the inherent defects aud 
shortcomings in our preseut public health laws. These two little out- 
breaks illustrated, as almost every similar outbreak does, statutory 
defects in more tliau one directiou. At the second visit the healtii 
authorities were found searcliing the Revised Statutes to see wiiat pro- 
visions were there contained as regards the burial and trausportatiou 
of bodies after death from the contagious diseases. Tliey found noth- 
ing. The friends of a little girl recently deceased from diplitheria 
were about to transport the body to another town for burial. If this 



24 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

were done it seemed very desirable for the safety of the town into 
which the burial party was to go, that certain precautions should be 
taken. The parents of the child promised to have the body disinfected 
before starting, and the chairman of the board of health went after 
disinfectants for this purpose. When he returned, however, he met 
the people with the corpse on their way to the neighboring town, not 
having waited to have the disinfecting precautions taken. I fear that 
in our neighboring States this would be considered an anomalous con- 
dition of sanitary atTairs that these things should occur while both the 
local and the State Board of Health found themselves powerless to 
interfere. Again, in one instance at least, a public funeral was held 
after one of the diphtheria deaths, and friends came from a distance 
to attend the funeral and remained some days. Again, precautions 
due to the public were not taken b}' a man who ran on the local train. 
As a result of this lack of care the disease was carried into other 
towns and gave rise to outbreaks in several families. 

DIPHTHERIA AND OTHER DISEASES IN BRUNSWICK. 

Through various reports the Board became aware in the early 
part of July that there was much more sickness than there ought 
to be, and that an excessive death rate prevailed, among the French 
population in certain parts of Brunswick. Accordingly I visited 
the town July 13. Unfortunately I was not able to see any of the 
members of the local board of health on account of their absence 
from home. I saw, however, Dr. Pare, in whose practice the larger 
number of the cases of sickness in this part of the village had oc- 
curred, and through his courtesy was able to gather many of the 
facts concerning the above-mentioned sickness and to examine the 
condition of many of the houses in which the recent cases of sick- 
ness had occurred. 

I could not learn that there had been an}' unusual sickness this 
year in any other part of tlio town or village excepting in tlie lower 
part, and particularly in that part near the mills of the Cabot 
Manufacturing Company. As regards the diseases wliich had been 
prevalent during the year 188G, during the first three months of 
the year there were quite a large number of cases of measles, from 
which there resulted about half-a-dozen deaths. During these same 
montlis, there occurred six deaths from typhoid fever, and five 
from acute lung diseases. In April there had occurred five deaths 



DIPHTHERIA IN BRUNSWICK. 25 

from (liphtlieria, one from typhoid fever and one from cerebro-spi- 
nal-nicningitis. In jMay the Doctor had seen twenty-nine cases of 
diphtheria, mosth" in a light form, from which two deaths had re- 
sulted. In June the number of eases of diphtlieria was not stated, 
but there occurred six deaths during that month from this disease. 
So far in July there had been fifty-six cases of diphtheria and diph- 
theritic sore throat with only three deaths from this disease. While 
talking with the Doctor a new case of diphiheria came into his office 
which he said was a fair sample of many of the milder cases. Tliere 
could be no question as regards the diphtheritic nature of this case ; 
the formation of false membrane, though of limited extent, was 
tough and adherent, not pultaceous and easily wiped away, nor did 
it proceed from the tonsillary follicles. In this part of the village 
there are many cases of typhoid fever every year, and one interesting 
fact mentioned was that, after every thaw which occurred in the 
winter, from three or four to a dozen very marked cases of typhoid 
fever were sure to follow in from ten to fourteen days. This, he 
said, had occurred not only in one winter, but in every winter since 
he had I)een in Biunswick. Another thing which he had noticed 
was that when French families first came into tliis part of the town 
they had almost always been attacked with diarrlura which had usu- 
ally been obstinately prolonged, and that it did not make much dif- 
ference whether the families arrived in the summer or in the winter. 
In summer there had always been ver}' many cases of the diarrha^al 
diseases among the children. Every year there had occurred cases 
of cerebro-spinal- meningitis. 

Visiting, in company with Dr. Pare, many of the houses and tene- 
ments in which these diseases had occurred, I found the sanitary 
condition generally of the worst possible kind. It resulted from an 
entire absence of any systematic method for removing and disposing 
of the various wastes which occur in such a population. 

Three days later another visit was made toBrunswick, during which 
I was able to see only one member of the local board of health. Soon 
after this a movement was made to empt^" some of the vaults, but 
whether any improvement in the sanitary condition of the premises 
resulted from it is very doubtful. Through the month of July com- 
plaints were continually received of the unendurable condition of 
this part of the village, and, as the number of cases of diphtheria 
had largely increase<l through this month, the town was visited ou 
the second of September by three members of the State Board of 



26 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

Health for the purpose of seeing what could be done to improve the 
conditions of things. In company" with Dr. Pare and one of the 
members of the local board of health, a careful inspection of the 
buildings and premises which were at fault was made, and the fol- 
lowing report was given to the local board and a copy of the same 
was sent to Mr. B. Greene, agent of the Cabot Manufacturing Com- 
pany. 

MAINE STATE BOARD OF HEALTH. 

Augusta, September 2, 18S6. 
To the Board of Health, Brunswick : 

For some weeks this Board has heard complaints concerning the preva- 
lence of diphtheria in Brunswick, and of the unhealthful condition of cer- 
tain premises in the immediate vicinity of the occurrence of most of the 
cases of this disease. Being requested to investigate the circumstances, 
we. the undersigned, members of tlie Board, visited the town on the 27th 
of August, and carefully examined the sanitary arrangements in and about 
many buildings in the quarter where we were informed diphtheria liad 
most prevailed, particularly those on the Cabot Manufacturing Company's 
grounds. 

We did not attempt to ascertain by personal examination the present 
prevalence of diphtheria iu the premises examined, as our Secretary had 
previously seen and recognized as diphtheria a case which Dr. Pare' had 
thus diagnosticated, and we were content to take this case as a sample of 
the disease and an evidence of Dr. Pare"s skill in distinguishing this af- 
fection from others with which it is sometimes confounded. Furthermore, 
we were creditably informed that a dozen or more deaths had occurred 
within a few months from the disease which was called diphtheria by Dr. 
Pare', who has treated a majority of the cases; and this fact confirmed 
our opinion that the malady which has afflicted the French quarter of the 
village was what it had been alleged to be. Tliat it has been of a mild 
type, has been marked by a comparatively small mortality, and is now sub- 
siding, arecirctunstances quite in accord with the frequent behavior of this 
disease, and do not in the least militate against the correctness of the diag- 
nosis, or diminish at all the necessity for extraordinary precautions against 
a return of the distemper. 

While, in the following description of the conditions which we observed 
and in our recommendation for their removal or iinprovenient, we 
especially emphasize the part played by filth influences in i)roinoting the 
spread of diphtheria, we would not have it understood that we ignore 
contagion as an important factor in its production. But this, in the exist- 
ing circumstances, needs only to be mentioned. We wish particularly to 
insifit tiiat aceunmlations of filth of any kind,— excrement, urine, swill, 
slop-water, and the like— In the neighborhood of human dwellings are 
dangerous to health and life, because they render impure the air that is 
breathed and the water that is drunk, thus lowering the tone of the system 



DIPHTHERIA IN BRUNSWICK. 27 

and rendering it more susceptible to the impression of malign influences 
of every sort and, in some cases, actually inducing disease of a fatal 
character. Further than this, these filth accumulations furnish material 
for the rapid propagation of the essential elements of such a disease as 
diphtheria, and thus aid in its spread through a community. For example, 
the matter coughed or spit out by a diphtlieria patient, being thrown into 
a privy, is at once received into soil which is singularly favorable for the 
development of this poison; and being borne on the air like offensive 
odors from excrement, or soaking through the ground to the nearest well 
or spring, is breathed into the air-passages or swallowed into the stomach 
of the healthy, some of whom have the seeds of the disease thus implanted 
in tlieir systems. 

We found the methods of disposinar of excreta and the common waste 
of dwellings to be of the worst character. The privies were all in horrible 
condition, some being so full that their contents overflowed on the surface 
of the ground. The sink-spouts were placed on the outside of the houses, 
■were badly made, were all extremely vile, and discharged for the most 
part very near the luiuses. In some places, the narrow space between two 
closel3-set dwellings was used as the receptacle for the most offensive 
waste-materials. Pig-sties were next to tenements, and cow-stables, 
reeking with liltii, were not far away. The putrid swill, destined for the 
food of cows, stood around in open buckets. Some of the wells and cis- 
terns were too near the privies and pools of decomposing liquid to escape 
serious contamination. In short, we found a conilition of affairs utterly 
inimical to the hygienic welfare of the people inhabiting the neighborhood, 
— a condition which would furnish a rational explanation why diphtheria, 
typhoid fever, and the diarrhceal di>eas'^s have been so pravalent. 

For the purpose of improving the health conditions of the above-men- 
tioned i)art of the town, we wish to make the following recommendations : 

1st. Very urgently we would remind you of the need of a radical change 
in the method of the disposal of human excreta. AVith the present ar- 
rangement of privies and vaults it is utterly impossible to keep the ground 
and dwellings in a condition fit to be the habitations of human beings of 
any class. 

We recommi'iid, tluMffore. as being under the circnmstances the most 
practicable, a system of box vaults into which dry earth or coal ashes 
shall daily be strewn for the purpose of absorbing the moisture as far as 
possible. These box-vaults should be made of plank, coated inside and 
out with hot coal-tar to make tlieni impermeable to fluids, and should be 
of moderate size that tliey may be eaj^ily drawn out and emi)tied at not 
too long intervals. This would reijuire that th ^ privies be placed in ac- 
cessible positions, that rhe present vaults be cleaut'd out and filled level 
full with Iresh earth, and the boxes placed wholly above ground. This 
system would also re(|iiii-e absohitely that all slops shall be excluded from 
the privy vault. Sonu- othti- systi-ni of disposal of them must be provided. 

2nd. With so large a number of persons to the acre as there is in the 
part of tiie village to which we now refer, sewerage is absolutely required. 



28 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

This need not be costly, even with the blasting, for the whole locality is 
close to tlie i-iver, deep drains are not reqnired and the cnts would need to 
be only wide enough to hold four and six-inch glazed earthen-ware drain- 
pipes. Tliese laid in a proper way might be flushed and washed thoroughly 
their whole length bj' means of a tank tilled from the mill or from the vil- 
lage water supply, thus giving a sewerage system on a small scale which 
would be a credit to any town or corporation. 

The kitchen and othei- waste water from the houses should be carried 
down ill pipes inside of the walls through the basement or sub-space to 
enter the drains. 

3rd. With the arrangements recomnaended under 1 and 2. properly 
cared for, the present supply of water from wells and cisterns would not 
be so objectionable as it now appears to be. The artesian wells probably 
supply a pure water. The otiier wells and even tlie cisterns are to be 
looked upon with extreme suspicion on accoinit of the nearness of prob- 
ab e sources of contamination. It is well known that a well 20 feet deep 
is sure of being aftected by the soakage on the surface of the ground at 
the distance of 100 feet, and this circle widens in proportion to the in- 
crease in the depth of the well. Sandy soils make this undesirable filtra- 
tion into wells the moi'e likely to occur. Brick cisterns, even when 
cemented, are quite porous and allow fluids to readily transude. 

4th. All garbage which cannot be disposed of under 1 and 2 should be 
carted off" regularlv. This might be done systematically' at little cost by 
the horse and cart that should be detailed a part of the time to empty the 
privies and supjily dry earth and ashes. 

5th. A frequent, careful inspection should be made by both the local 

health authority and by the corporation, to see that ever3^thing is kept 

neat and clean. 

FUKDEKIC II. Gkukisii, M. D., ] Members of 
Edwaki) 0. Jordan, C. E., \ State Board 
A. G. Young, M. D., J of Jlmlth. 

Immediately after this visit I requested Dr. Pare to prepare for me 
H list of the deaths vvhicli had occurred during the year among the 
French population of the village, giving, in couuectiou with each, the 
date of death, the name, tiie cause, and the age. lu accordance 
with this request he sent me the list to tlie end of August, copied 
from the church records, and at the end of the year the Rev. J. P. 
Gorman kindly furnished me with the mortality record for the last 
four months. For tlie whole year it is as follows : 

Date. Niiino. 

Jan. 2, Edward (iagnion, 

" 3, Marie Gaguion, 

" .0, Carolina Desjardins, 

" 10, Louis Lcclairs, 

" 11, Francois IJergeron, 



Cause. 


Age. 


Measles, 


2 years. 


Measles, 


5 


Typhoid Fever, 


2 " 


Epilepsy, 


20 " 


Typhoid Fever, 


1 year. 



DIPHTHERIA IN BRUNSWICK. 



29 



Date. 


Name. 


Cause. 


Age. 


Jan. 


14, 


William Labbei, 


Measles, 


9 months. 


(( 


14, 


M. B. Cardillac Labber, 


Measles, 


3 years. 


i( 


16, 


Magenic Thebault, 


Typhoid Fever, 


4 " 


n 


18, 


Joseph Drapeau, 


Pneumonia, 


28 " 


(( 


21, 


Marie Beaulier, 


Diarrhoea, 


2 months. 


Feb. 


15, 


George Mercier, 


Measles, 


2 years. 


Mar. 


11, 


Milfred Colombres, 


Typhoid Fever, 


2 '' 


i( 


13, 


Marie Dione, 


Acute Lung Dis. 


6 months. 


(( 


14, 


Adelle Reneau, 


Typhoid Fever, 


14 years. 


(( 


18, 


Aglaie Rineuu, 


b i, 


18 


(( 


21, 


Joseph McMahon, 


Bronchitis, 


4 


(( 


26, 


George Biillant, 




1 day. 


K 


26, 


Henry McDuff, 


(t 


2 years. 


(( 


26, 


Archus May, 


Measles, 


1 year. 


April 


13, 


Marie St. Marie, 


Diphtheria, 


2 years. 


a 


13, 


Elixis St. Marie, 


n 


3 '' 


ii 


16, 


Emile Labre, 




3 " 


n 


17, 


Marie Gauther, 


C( 


1 " 


n 


19, 


Napoleon Ray, 


Typhoid Fever, 


14 " 


n 


19, 


Pieire N. Letarte, 


Cerebro Spinal 

Meningitis, 


7 months. 


a 


26, 


Josephine Terdiff, 


Diphtheria, 


21 


n 


30, 


Exziiia Lebel, 


"■ 


3 years. 


May 


19, 


Alfred Gadrault, 


li 


2 " 


(( 


27, 


Alfred Jacques, 


(( 


1 3'ear. 


June 


4, 


Catharine Leclairs, 


Gangrene of feet, 


60 years. 


( I 


11, 


Marie Forten, 


Diphtheria, 


2 '' 


u 


13, 


Joseph Aubus, 


p:pilepsy, 


52 " 


(( 


24 


Marie Lebel, 


Sequel Diphtheria, 


1 7 months. 


(( 


25 


Joseph Carou, 


a 


15 


(( 


29 


Joseph H. Baribeau, 


(( 


7 " 


(4 


29 


]\Iarie L. Dubie, 


Diarrhoea, 


1 year. 


(I 


30 


Rosanna LeBlance, 


Diphtheria, 


9 years. 


July 


5 


, Annand Desjardins, 


" 


2 '' 


(( 


7 


, Marion Desjardins, 


Diarrhea, 


8 months 


ii 


15 


, H. E. Duniout, 


Typhoid Fever, 


3 years. 


(I 


15 


, Eugene Garmach, 


Diarrho.'a, 


8 months 


i( 


16 


, Alice Bellanger, 


a 


5 »' 


a 


16 


, Bernadette Caron. 







30 STATE BOARD OF HEALTH SECRETARY'S REPORT. 



Date. 



Name. 



Cause. 



July 20, Michael Quintal, 

" 20, Ainede Tbeberge, 

" 20, Louis LeBel, 

" 21, Marie O. LeBel, 

" 22, Adelord Silvest, 

" 28, Glevia Levesque, 

Aug. 7, Joseph Thebault, 
" 9, Marie Dumont, 
" 9, Marie O A. Tetu, 

" 10, M. E. Lcplant, 

" 17, Alphosin Revando, 

" 20, Augustin Caron, 

" 21, Horace Michaud, 

" 21, Hanna Terrien, 

" 23, Rose Caron, 

" 24, Remued Thebault, 

*' 25, Elbridge Desjardins, 

" 26, Joseph E. Lapoint, 

" 28, Marie Lavois, 

" 29, Jos. Alford Duchiune, 

" 28, Francois Caron, 

Sept. 3, Joseph Chuonard, 

" 3, Joseph Couiltard, 

" 5, Pitre Dutbrt, 

" 20, Charles Merdere, 



Diphtheria, 



Sequel Diphtheria, 

Diphtheria, 

Exhaustion, 

Diphtheria, 

Typhoid P^ever, 

Diarrhoea, 



Typhoid Fever, 

Consumption, 

Diphtheria, 

Diarrhoea, 

Typhoid Fever, 

Diphtheria, 

Diarrhroa, 



Diphtheria, 

Whooping Cough, 
Consumption, 



24, Charles Sebastian Ragot, Bronchitis, 



Oct. 



Nov. 



Dec. 



Don't know, 
Whooping Cough, 



Whooping Cough, 



25, Lorea Leclair, 

10, Ad(!laid Fanquet, 
IG, Joseph Thomas Tetu, 
22, Joseph Legros, 
28, Joseph Couiuard, " 

9, Marie Oleviue Normaud, Consumption, 
21, Margarite Bourgoin, 

nee Laforge, 
14, Joseph Amede Caron, Sore Throat, 

26, Albert St, Pierre, Whooping Cough, 
26, Julian St. Pierre, " 



years, 
months. 



Age. 

4 years. 
1 month. 
1 day. 
8 months. 
13 " 

4 " 
5 
8 
4 

5 " 

1 month. 

32 years. 

33 " 

2 " 
69 " 

6 " 
1 year. 

1 " 

6 months. 

7 

9 " 

2 years. 

2 " 

5 mo, 15 d. 
34yrs. 6mo. 

3 yrs. 6mo. 
24 days. 

1 3'ear. 

1 day. 

2 months. 

1 year. 

5 years. 

85 " 

2 yrs. 8mo. 

6 months. 
6 " 



This list is a sad commentary on a wrong state of things. It is 
also interesting and instructive and for being so is given here in full. 



TYPHOID FEVER IN VAN BUREN. 



31 



We find that in this community of about 1,G50 inhabitants, there 
were 78 deaths, giving a death-rate of 47.2 per 1,000. Running the 
eye down the list we find that nearly all the deaths were from the 
zymotic diseases. Six deaths from measles, eleven from typhoid 
fever, eleven from diarrhoeal diseases, 21 from diphtheria, one from 
cerebro-spiual-meningitis, three from consumption, and six from 
whooping cough. Another thing is shown in this list. It is well 
known that children are much more susceptible to the more prevalent 
causes of disease than are adults. The contagion of the zvmotic 
diseases, filth, want of ventilation, polluted water — all these show 
their baneful influence most markedly upon the child population. 
Again running the eye down the list, we find that of the 78 deaths 
33 were of the age of one year or less, and that 62 were of the age 
of 5 years or less. 

The following gives a comparative view of the deaths by mouths 
for the last three years : 



January, 

February, 


1884. 
Deaths. 

2 

1 


1885. 
Deaths. 

2 
3 


1886. 
Deaths. 

10 

1 


March, 


1 


2 


8 


April, 

May, 

June, 


6 
3 
2 


1 

4 
none. 


8 
2 
8 


July, 

August, 


7 
5 


5 
none, 


12 
15 


September, 

October, 

November, 


3 
2 
3 


2 
none, 
5 


5 
4 
2 


December, 


5 


4 


3 



39 



28 



78 



TYPHOID FEVER IN VAN BUREN. 

September 24th, while waiting in Caribou a few hours for the train, 
I made some enquiries about a fever which, incidentally a short time 
before, I had heard was prevailing in Van Buren. The report which 
I had received in the office was that a fever of some kind prevailed, 
that it lasted only a short time, and that all the patients recovered 
rapidly. I learned at the hotel where I was waiting that it was far 



32 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

different ; that there were then quite a large number of persons sick 
with the disease, that one, the representative-elect, Charles Farrell, 
had alread}' died, that several others were not expected to recover, 
and that in answer to a summons by telegraph, Dr. Thomas of 
Caribou had gone up there earl}^ in the morning. Waiting a few 
hours until the Doctor returned, I got a team and drove up in the 
evening. The next day, the 25th, was spent in investigating the 
history of the outbreak and its causes. 

From Dr. G. C. Upham, to whose kindness I am indebted for much 
help in getting the facts regarding the outbreak, I learned that there 
had so far been eighteen cases of typhoid fever in the village. The 
following is a list of the names of the fever patients and as far as 
could be obtained, the date, or approximate date, of the beginning 
of the sickness of each. 



X 


12, 


Mrs. J. B. Farrell, 


July 


1. 


X 


7, 


Mr. Douglass, 


Aug. 


13. 


X 


3, 


Charles Farrell, Jr., 


Aug. 


22. 


X 


9, 


Mrs. Soucis, 


Aug. 


28. 


X 


2, 


Charles Farrell, 


Sept. 


5. 


X 
X 


5, 
4, 


J. B. Boyd, 
Geo. Watson, 


Sept. 
Sept. 


5. 

7. 


X 


12, 


Miss Gagnon, 


Sept. 


7. 


X 


8, 


Nellie Pike, 


Sept. 


14. 


X 
X 
X 
X 


6, 
6, 
6, 
6, 


Mrs. Hall, ^ 

Child, I 

Child, 

Servant, 


Sept. 


14. 




11, 


Mrs. Davis, 


Sept. 






13, 


Joe Bernard, 
Johnnie Ward, 


Sept. 
Sept. 




X 


5, 


John De Rosa, 


Sept. 


18. 




10, 


Allen Hammond, 


Sept. 


23. 



Since the 25th of September there have been five cases in the vil- 
lage whose names and the dates of whose attacks I have not been 
able to obtain. It will be noticed that the first illness of most of 
these cases must be referred to the period of time included in the 
last week of August and the first three weeks of September, and 
that the larger number began during the first half of the latter month. 

Until this season there had never occurred in this village an out- 
break of typhoid fever nearly so extensive as this. There was no 




2^ 



TYPHOID FEVER IN OTHER TOWNS. 32 a 

history within recent years of anything more in the village or sur- 
rounding country than a few isolated cases at a time, usually affecting 
a single family, or a few houses. 

An examination of the village ami particularly ot the premises 
where the cases had occurred, and a careful inquiry into the facts 
gave the following : 

[ The principal street of the village, and the one on or near which 
most of the cases of fever had occurred, runs in a direction nearly 
parallel to the St. John River and at a distance of about 40 rods 
from it. As will be seen by the map, a road runs from this street 
to the ferry, and a little way below the ferry is a large steam saw 
mill. Near this ferry road, and a little way up from the river, there 
is a spring fiom which almost all of the village had obtained the 
drinking water, including the fifty or sixty hands who worked in the 
mill. All the other sources of water supply which had been used in 
that part of the village in which the fever prevailed were two private 
wells and one aqueduct. One of the wells, a deep one, is dry much 
of the time and had been lor some time before the beginning of the 
fever, so it may be left out of account ; the other was at house No. 
5, where two of the fever cases originated, and it was only six feet 
in depth and had only eight inches of water in it at the time of my 
visit. This well was so situatcil that it could not fail to be badly 
polluted with soakage from the sink-spout, stable and privy. The 
two cases, however, which occurred in this house were in men who 
worked in the mill and drank the water from the spring. The aque- 
duct came from a spring which was situated to the west and above 
the town and where there was no suspicion of the water. It sup- 
plied the hotel and one other house before it reached the hotel. Ex- 
cepting the hotel and this other house, the village was generally 
supplied with drinking water by bringing it from the spring, a pail- 
ful at a time. 

There was no common milk supply, each house in most cases 
owning its own cow, and, though the local sanitary conditions of 
the houses were often at fault, there was nothing which could be 



32 h STATE BOARD OF HEALTH SECRETARY'S REPORT. 

regarded as a common source of the contagion except the spring. 
Additional circumstances which served to cast suspicion on the 
spring were these : The village rests upon a shallow soil beneath 
which, at the depth of onl}' a foot or two, there is an impervious 
hardpan, or stratum of cla}-. This peculiarity of soil and sub-soil, I 
was told, extends over all this part of the village and to the river. 
Below the village there extends somewhat diagonall}'^ through a 
meadow, a little swale or "run" in which there is found no water in 
the dry season, but which is filled b}- ever}- shower and pours its 
surface wash into the outlet of the spring at the distance of perhaps 
twenty feet below the spring itself. Just below the junction of this 
•'run" and the little brook from the spring there is an old dam 
which was built some 3'ears ago to suppW water for a steam engine. 
This dam is onl}' two or three rods from the spring and there is but 
ver}' little fall from the spring to the dam ; consequeutl\% every time 
a shower occurs the surface wash flows back into the spring. This 
" run" takes the wash from the principal part of the village, includ- 
ing the hotel stable and its pile of manure, which are on the lower 
side of the street. 

But there is a second way in which it does not appear unreason- 
able that the spring could become polluted. On account of the con- 
siderable inclination of the ground from the principal street to the 
spring, it would be quite conceivable that the drainage from the 
houses and the out houses might settle into the soil until it reached 
the impermeable hardpan and then flow rapidly in tlie direction of 
the spring until it met and mingled with its sources or feeders. The 
results of the chemical examination of a specimen of the water 
which Mr. W. G. Hammond, Jr., kindly sent to this office would 
seem to give some support to tlie possibility of this latter way for 
noxious matter to reach the spring. The specimen was sent to Prof. 
F. C. Robinson of Bowdoin College, and he reported that "it is 
badly contaminated with animal matter, — is in short the worst 
water I have examined for some time." 



TYrHOID FEVER IX OTHER TOWNS. 33 

At the time ^vhen the jnnffiil of water was taken from the spring 
there was no setting back of the water of the "run" into the spring, 
nor had there been recentl}' enough rain to lead to the sujjposition 
that the s[)ring was then eontaniinated with the surface drainage. 

Tiie reasoning which would indicate the spring as the source whence 
the people derived the cause of the fever was largely' a process of 
exclusion. As has already been remarked, there seemed to be no 
other possible way to account for the somewhat sudden appearance 
of a considerable number of cases in so many houses at about the same 
time. I would now, however, call attention to other facts in con- 
nection with this outbreak which are not without interest and which 
may be said to throw some light upon its causation. By referring to 
the map and to the list of cases, it will be observed that the sickness 
of the first case began Jul^- 1st, and that the house (numbered 12) 
in which it occurred was located on the lower side of the principal 
street, directly above the spring. From this case it would seem quite 
likel}' that the contagion of the disease, thrown out either in the 
alvine discharges, or in the wash water, may have reached the spring. 
This would be more likely to happen during some shower that might 
occur. Unfortunately there are no records at hand pertaining to that 
place which would show whether anj" showers occurred near or shortl}' 
before that interval of time to which we would refer the reception of 
the poison by the larger number of the patients. 

The date which follows each name gives the beginning of the 
attack for the given case, the figure which precedes the name refers 
to the house on the map in which the case occurred, and the mark 
(x) before a name indicates that tlie person used, or probal)ly used, the 
water of the spring. Of the four which are indicated as not having 
used the water, the first was at the hotel and used the water which 
was supplied by the aqueduct. There is no certainty that the others 
did not, at times, drink the water from the spring. 

TYPHOID FEVER IN OTHER TOWNS. 

In several other towns in the State outbreaks of typhoid fever 
have been reported to the Board and requests made for a personal 
visit and examination of the localities where the disease had ap- 
peared. A somewhat exaggerated newspaper report represented 
that there were in the beginning of October thirt}' cases of typhoid 



34 



STATE BOARD OF HEALTH — SECRETARY S REPORT. 



fever in the village of Fairfield. Through a personal visit to the 
place it was learned that the number of eases in the town had been 
somewhat greater than was found in the average season. But the 
number of cases which had recently occurred was not more than 
one-third of what had been reported. An examination of several 
premises where typhoid fever had lately occurred was made and in 
one case, particularly, conditions were tound which were certainly 
unfavorable to health, and could be readih' believed to act as a cause 
of the fever. The following ilhistration will show the arrangements 
at one of the houses where the fever prevailed. 



> 



V 



Stable. 



O 



Wood Shed. 



Kitchen. 



A 



House. 



TYPHOID FEVER IN OTHER TOWNS. 85 

1. Represents a shallow well with the water within four or five feet 
of the surface. The water in the well is not cold and is decidedly 
roily or milk3\ The ground inclines sli^^htlj' in all directions towards 
the well, as shown by the arrows. 

2. Represents a shallow furrow or ditch, the lowest point of which 
is opposite the well. 

3. The privy thirtj* feet or less from the well. 

4. Hog yard about twenty-five feet from tlie well. 
0. Stable onlv four or five feet from the well. 

6. Rear of several houses and outbuildings the descent from 
which to the well is more considerable than from other directions, 
and tlie surface wash from which is caught by the shallow ditch. 

In another place where a death had occurred from the disease, 
the cause was not apparent. Attention, however, was called to the 
fact that the cow which supplied the family with milk stood while 
in the stable so that her head was directly over the privy vault, 
which latter was in an offensive condition. It was an interesting ques- 
tion as to what extent the poison inhaled b}' the animal under these 
circumstances would be eliminated in the milk supplied. Though 
under the circumstances it would not be safe to venture an opinion 
that the milk thus polluted had been the cause of the fever, there 
have been cases enough observed in which disease has been trans- 
mitted by milk which has been made unwholesome by the unhealthy 
conditions and surroundings of the cow, to make it very apparent 
that it is not at all safe to use the milk from cows circumstanced as 
this one was. 

In anolhor town a family was visited in which the fever could 
not be traced to any anterior cases outside of the family. The 
house was on a dry knoll some little distance from the road and 
from neighboring houses, the well was distant from the house and 
other buildings and furnished no reason to suppose that the source 
of the contagion could be sought in this direction ; the privy and 
other outbuildings were also distant from the house, and there was 
no history of any previous sickness in or around the house resembling 
typhoid fever. The cellar, however, was not walled up but was said 
not to be wet, and there was abundant testimony that the general 
domestic economy was exceedingh' filthy. 

Tiie first case, a little boy of ten years, was attacked with a mild 
form of typhoid fever, August loth, and recovered. The second, 
third, and fourth cases were attacked respectively September 18th, 



36 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

23rd and 25th, and died respective!}' September SOtb, October 

and September 28tb. The father had a mild form of the disease and 
the mother was sick after my visit. 

The most rational explanation which could be given of the sudden 
outbreak of the cases in September was that the contagion from the 
first case had infected the privy vault or, Avhat is still more likely, 
had been ingested through lack of care and cleanliness. 



NUISANCE IN DEERING. 

Saturday, May 2'J, the president and secretary of the Board vis- 
ited Capisic pond in Dcering for the purpose of inspecting the pond 
and its surroundings as regards alleged nuisances. For years a lo- 
cal nuisance had existed in the shape of a tripe factoi-y and bone- 
boiling establishment. The water which came from this and which 
crossed the public highwa}- below the factory and flowed a consider- 
able distance through meadows before it reached Capisic pond, made 
the air very offensive the whole length of the little brook and had 
completely spoiled the little sheet of water which is known as 
Capisic Pond, and from which formerly there was gathered ice of a 
very excellent qualit}'. Some cases of sickness had lately occurred 
near the pond which the inhabitants had attributed to the unsanitary 
conditions of the surroundings of the pond. At the time of our 
visit one case of typhoid fever existed in the house at the foot of 
the pond, and the family attributed the origin of the case to the 
inhalation of the stench which arose from the brook which flowed 
into the pond from the tripe factory. The well which supplied the 
drinking water of this house was beneath the house in the cellar 
and probably not more than twenty-five or thirtj'^ feet from the mar- 
gin of the pond. A special town meeting had been called for the 
purpose of seeing what action would be taken in regard to the 
nuisances, and our report was requested so that it could be pre- 
sented to the meeting. The following report was left. 

Portland, May 29, 188G. 
To Warren Harmon and others^ inhabitants of Deering : 

111 compliance with your written refjuest for an oflicial opinion concern- 
ing the sanitary condition of tlie noi^^liborliood of Cnpisic Pond, we liave 
this day visited tlic locality and have jxM'Ronally made an investigation of 
the pond and its tributary brooks. The time at our disposal between the 
completion of the survey, and the town meeting, at whicli we understand 
you wish to make use of our opinion, forbids a detailed report; but we 



VISIT TO NORWAY. 37 

believe that a concise statement of our conclusions will meet all the 
practical requirements of the case at pi'esent. 

We Unci the water of the pond extremelj' filthy and, cnnsequentl}', 
entirely unfit for domestic purposes. The diinkin<^ of such water would 
be productive of disease, as also would the ingestion of ice formed in the 
pond. The impurity of the water we attribute to the dischar<j;e into the 
pond of the waste materials from the tripe factory and bone-boiling estab- 
lishment near the town-house. 

Not only is the water spoiled, but the air of the entire region around 
the pond and the stream Avhich runs into it from the establishment men- 
tioned is so polluted with emanations from putrefying animal matter as 
to be very offensive to the sense of smell and injurious to health. We 
believe this state of affairs to constitute a nuisance, and to fall within 
the statutorj^ regulation which provides that municipal officers shall 
remove accumulations of filth which menace the public health. 
Very sincerel}"^ yours, 

Freueric Henry Gerkish, M. D., President. 
A. G. Young, M. D., t'Secretai-y. 

At the town meeting, whieli was held on the afternoon of the same 
day, tlie 2"Jth, the selectmen were by vote instructed to proceed 
against all nuisances when complained of by three citizens in writing. 
The tripe and bone-boiling establishment was subsequently removed 
from that neighborhood. 



VISIT TO NORWAY. 

At the instance of the municipal oflicers of Norway, that town 
was visited July 22, for the purpose of examining its sanitaiy con- 
dition and advising them in regard to what improvements seemed 
required. The village, like many other of our Maine villages, was pre- 
paring to introduce a general water supply. The source was to be 
Pennesseewassee Pond, a mile or less above the village. Tlie put- 
ting in of a supply of water, such as this seems to be, is a decided 
move in the direction of gaining for a town the best possible condi- 
tions for healthfuhiess ; but with tlie very great advantages wiiicli 
come from furnishing a purer supply of water for drinking and a 
greater abundance of it for purposes of cleanliness, there comes in 
an undrained or unsewered town an offsetting evil. The water, 
which at every house runs to waste, increases the soil-dampness in 
a marked degree, and tliis increased saturation of the soil with 
water, and especially with dirty water, is a considerable evil. This 
the people of Norway were aware of, and hence sewerage for the 



^8 



STATE BOARD OF HEALTH — SECRETARY S REPORT. 



village came to be regarded as an improvement which must speedily 
come. But irrespective of the new water supply, sewerage has for 
some time been very much needed. The increase of the various 
branches of manufacturing in the village has brought together many 
work people, in some cases under the same roof, and in and about 
these larger factoiies the disposal of human and manufacturing 
wastes has come to be a serious question, the solution of which with- 
out a system of sewerage seems to be hard or impossible. 

The following report was made to the selectmen : 

Office of State Boakd of Health, 1 
Augusta, July 27, 1SS6. / 

To the Municipal Officers, Norway: 

In the necessarily brief visit which, a few days a,i>'0, I made to your vil- 
lajje, I noted the following facts which have a relation to its health con- 
ditions : 

Most of the way from the foot of the pond to the "Steep Falls " the 
Pennesseewassee River runs, either naturally or from artificial obstruc- 
tion, a very sluggish course. A part of this distance the stream flows 
through marshy interval lands, which a slight rise in the water overflows, 
and wliich an inconsiderable falling leaves partly exposed to the air again. 
AVith these conditions, and the further one, that, in especially the hotter 
and dryer season of the year, tlie volume of water flowing in the stream is 
very small, it would be very unwise to think of discharging the sewage 
of the village, either wholly or in part, into the above-mentioned portion 
ot the stream. It is also very apparent that a wise provision for the healtli 
interests of the town should also forbid the continued wholesale pollution 
from other sources. The using of small brooks or streams in villages as 
the common receptacle into which to discharge water-closets and i)rivies, 
as well as to throw decayed vegetables and dead animals, is reprehensible, 
and a general regard for the public welfare should seek to rectify such 
errors as soon as possible. 

Some of the sanitary conditions of your village do not admit of imme- 
diate rectilication ; others can and sliotdd be undertaken at once. One of 
the most serious of the former is the fouling of tiie lower part of Shallow 
Brook by the shoe factory and taniier}^ The intolerable stench, however, 
coming from the tannery may and should be mitigated by the prompt re- 
moval of all accumulations of the scraps and fleshings and other waste 
parts. 

Some of the undesirable conditions which have been referrcid to as not 
admitting of immediate removal can be removed by the a(loi)tion and 
building of a syst(;m of sewerage, and probably in no other way. It 
seems advisa]>le that the town should iujinediately take this matter into 
consideration. If the town should see flt to act in this nnitter, a complete 
survey of tlie village, and a systematic plan of the whole sewerage system 
shoidd be made before a pipe is laid down. The unsystematic and frag- 



OTHER PLACES VISITED. 39 

mentary way in which the sewers liave been put into most of the towns 
of Maine which have any sewerage, is very unsatisfactor}' in results and 
much more costly in the long run than would be a systematic plan at the 
start and good work done in accordance with that plan, either all at once 
or extending over a series of years, as the town migiit elect. The waste 
resulting from working in a hapliazard way is often more costly than 
would be the paying of tlie interest on an indebtedness incurred for per- 
manent drainage improvements planned and done in a better way. 

Respectfully, 

A. G. Young, Secretary. 

Various other places have been visited, usually at the request of 
the local health authorities or others. Bar Harbor was visited with 
reference to the question of garbage disposal. In previous years the 
wa}' in which garbage had been taken care of seems to have been 
somewhat unsystematic and gave rise to some dissatisfaction. It 
was transported in carts two or three miles out of the village and 
buried or otherwise disposed of upon a farm. The carts in use were 
not specially designed for the purpose and consequentl}- leakage along 
the highway was complained of. This year, a contract was made to 
have the garbage carried out in a steam scow two or three miles from 
the town and dumped where the current constantly sets seaward. 
The Board understand that this method of disposal has been more 
satisfactory than the old method as far as Bar Harbor and its vicinity 
is concerned. The point of departure, however, of the scow is some- 
what objectionable, at least from an resthetic point of view, on ac- 
count of its proximit}' to some ot the principal hotels. Tiie method 
of garbage disposal by cremation b}' means of furnaces specially 
constructed for this purpose was suggested to the local board of 
health as probably olfering a better solution of this question than any 
other method for Bar Harbor and our other summer resorts. As re- 
gards this, the attention of the reader is called to what is said in 
this report under the heading of "Garbage Furnaces."' 

Brewer was visited at the request of the chairman of the local board 
of health for the purpose of advising in regard to certain nuisances, 
and also in regard to improvements in the way of sewerage and 
drainage. 

At the request of the trustees of the State Normal Schools, the 
Normal School building and its boarding house in Gorham were vis- 
ited by E. C. Jordan, C. E., member of the Board, and the Secretary, 
on August 16th. The sanitary condition of the boarding house, on 
account of the lack of proper drainage and sewerage, was found to 



40 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

be bad. A report was roade to the trustees detailing the changes 
which ought to be made, and on account of the late publication of 
this report we are able to say that an appropriation was made b}' the 
Legislature for the needed changes, and also for making some 
improvements in the Normal School Building, which were recom- 
mended in the report. 

CIRCULARS. 

The two following new circulars have been issued for general dis- 
tribution. 

Contagious and Parasitic Diseases of Animals. 

The law establishing the State Board of Health provides that 
" the}' shall investigate the causes of disease occurring among the 
stock and domestic animals in the State." To those who are aware 
of the close relationship which exists or may exist between the dis- 
eases of animals and those of man it will appear eminently fitting 
that the sanitary supervision of the State should not be restricted to 
human diseases. This idea of the inter-relation between the diseases 
of man and of animals rests upon the fact of the communicabihty to 
man, through contagion, of certain of the diseases of animals, and, 
vice versa, of the transmissibility of certain human diseases to ani- 
mals ; and of the further fact that the deterioration as a result of 
disease of the quality of the meat and milk supply' may be a cause 
of human disease. 

As far as concerns the transmission of diseases from the animal 
to man, or from man to the animal, it may be said that man is the 
greater sufferer in this exchange, for, whereas there are but few of 
the human diseases which may be given to animals, as diphtheria 
and tuberculosis, the number of animal diseases which may be com- 
municated to man is considerably greater ; among them may be men- 
tioned glanders, tuberculosis, anthrax, rabies, foot-and-mouth dis- 
ease, diphtlieria, and actiuomycosis. As affecting the food supply, 
not only tlie contagious diseases which have been enumerated but 
other contagious and non-coutagious maladies may render the meat 
or milk supply positively dangerous. 

Aside from the questions of puljlie health, there are other important 
questions of human interest involved in the consideration of the con- 
tagious diseases of animals, — that is, the question of economics, of 
profit and loss. So far, we have been remarkably fortunate in our 



CIRCULARS. 41 

comparative exemption from those epizootic diseases which may 
swiftly and fatally sweep over a country, or which, like pleuro-pueu- 
monia and tuberculosis, may more slowly aud insidiously disseminate 
themselves. From either the more swiftly or from the more slowly 
spreading diseases, the pecuniary losses may be enormous. In Eng- 
land in 1865-6 the cattle plague destroyed 500,000 cattle ; in France 
the loss among sheep from anthrax was until lately 20,000,000 francs 
annually ; in Hungary in a few years, glanders destroyed 20,000 
horses ; swine plague has some years caused a loss of $20,000,000 
in the United States ; and pleuro-pnenmonia cost England during the 
first twenty-five years after its introduction into that country nearly 
$500,000,000. These examples show bow great a blow to our ma- 
terial prosperity' the importation and failure to promptly prevent the 
spread of these animal plagues ma}' bring us. 

With the greater prevalence of some of these diseases in some of 
the states and countries from which importations of cattle and other 
animals are made, our continued exemption from these animal dis- 
eases can probably only be continued b}' means of laws touching this 
subject not far behind existing veterinary knowledge. But in addi- 
tion to wise laws and systems of veterinary police the effectiveness of 
any such precautionar}' arrangement, as in human sanitary matters, 
must depend largely upon the intelligent watchfulness and coopera- 
tion for their own good, of the local authorities and of the people at 
large. To help somewhat in this direction, this circular is published 
for distribution among those who are interested in, or have the care of 
stock, and for those local authorities whose duty it is to guard against 
the spread of their contagious diseases. In it only those infectious 
diseases are mentioned which are liable to spread and assume the form 
of a serious and fatal epizootic, or which are special!}- dangerous to 
human life and health through their infective or parasitic qualities. 

Glanders 

Is a specific disease propagated by contagion and contagion onW ; 
and never caused b}* exposure, poor feed and the other unfavorable 
conditions to whicii many horses are subjected. It is a disease af- 
fecting principally horses, but may be transmitted to man and to all 
the domestic animals except cattle, and must be considered incurable. 
The infectious principle which gives rise to the disease exists in the 
nasal discharges, in the expired air, and in the purulent discharges 
from the glanders ulcers. According as the disease affects principall}' 



42 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

the nose, the hings, or the skin, it is usualh' cleseribed as nasal, pul- 
monary or cutaneous glanders, — the last is known as farcy. Accord- 
ing to duration, it is classed as acute or chronic. Acute glanders may 
terminate in from ten to fifteen days, while the chronic form may last 
for months or years. The chronic or slow form is much the most com- 
mon. Farcy or external glanders is usually the most rapid in its 
course. Nasal glanders is usually slower, but the pulmonary form 
of the disease is the most chronic, being often prolonged to two or 
three years before a fatal termination occurs. 

The most characteristic sj'mptoras of nasal glanders are these three : 
discharges from the nose, swelling of the glands beneath the jaw, and 
ulcers of a peculiar kind in the raucous membrane of the nostrils. The 
first, — the discharge from the nose, — taken alone, is not a trustworthy 
symptom, but with the presence of one or both of the others, we may- 
be tolerably sure of the nature of the disease. 

Pulmonar}' glanders may remain latent or concealed for a long time, 
— for months or years, — and all this time the diseased animal is a 
source of danger to his fellows and to the persons who care for him. 
During all this time the horse may appear to be in good condition, 
excepting some respiratory trouble which would be likel}' to be at- 
tributed to " heaves." There is a " peculiar, weak, and dry cough ;" 
if, furthermore, other s^-niptoms of glanders should develop, and if 
the animal in question is known or suspected to have been exposed to 
the contagion, and particularly if other horses after having been with 
this animal, show symptoms of glanders, we should have a strong sus- 
picion of this disease and should take precautionary^ measures to pre- 
vent other animals from being affected. 

In the external form of the disease, or farcy, some constitutional 
symptoms usually precede the local manifestations. The latter con- 
sist of circumscribed inlhimmatory swellings or ''farcy buds." These 
superficial tumors, which appear more frequently where the skin is the 
thinnest, — inside the limbs, along the side of the neck, on the face, — 
soon soften and break, forming open, ragged, cup-shaped sores, or 
ulcers, which have a constant tendency to enlarge, rarely to heal. 

More than one of these three forms are often found in the same 
animal. Nearly every chronic case dies at last with the aggravated 
symptoms of the acute form. 

As ever}' case of glanders is a constant danger to every other horse 
which comes near him, and, to every person who cares for him, a 
constant menace of death from a loathsome disease, it is evident that 



CIRCULARS. 43 

justice and Inimanit}- alike demand that every declared case of this 
disease be promptly destroyed, and every suspected case strictly quar- 
antined. Ever}- glandercd liorse which goes at large or is driven on 
the public roads endangers other animals through the medium of 
hitching-posts, watering troughs, and other things which the infected 
horse has come in contact with, f^verything which may have become 
infected should be disinfected. Bedding and tainted hay or grain 
should be burned. 

Pleura- Pneumonia. 

A contagious disease of the lungs and their coverings in cattle. 
Infectious Pleuro-Pneumoniii is a disease which is noted for its vaga- 
ries. At one time it may be of a verv malignant type, destroying 
life in a few days ; at another it may assume a mild form. At one 
time, perhaps not more than five per cent of the cattle exposed to the 
disease contract it, in other cases nearly all in a herd take the disease 
from a single infected animal. The period of incubation, that is, the 
time which elapses from exposure to the contagion to the appearance 
of the disease, is very variable, being sometimes not more than eight 
or nine days, or it ma}- be three or four months before the disease 
shows itself. It is a particularly dangerous disease on account of its 
frequently insidious character. It ma^- exist in animals for weeks, all 
the time exposing the well members of the herd to danger, before its 
dangerous nature is discovered. During this time, while it is in this 
latent or concealed form, the affected animals ma\- appear to be in per- 
fect healtli, or it may be noticed that there is a slight cough or that 
there is a partial loss of appetite for a few days. Another circumstance 
which increases the danger of spreading the infection is that there may 
be an apparent recovery while the animal may still bear al)out with 
him the power of giving the disease to others for an indefinite time, 
— some say as long as twelve or fifteen months. 

In well marked cases of the disease the symptoms are similar to 
those produced by the ordinary non-contagious acute inflammations of 
the lungs and pleura : — loss of appetite, slight shivering, fever, rough- 
ening of the hair, an occasional cough which is dry and hard, breath- 
ing rough, harsh and painful, usually constipation, and, if a cow, 
diminution or cessation of the yield of milk. 

There is nothing in these symptoms which is very distinctive and 
the history or suspicion of contagion is often required to complete the 
diagnosis. The disease may be confounded with tuberculosis, with 



44 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

the " lung- worm disease," or with the acute non-contagious king in- 
flammations. 

Contagious pleuro-pneuraonia is propagated in no other wa}' than 
by infection. The poison is supposed not to be ditfusible through the 
air to any great distance, so there is no danger of the spread of the 
disease to other herds except by the movements of cattle ; therefore a 
rigid restriction should be put upon the movements of all cattle in in- 
fected regions, and both the diseased and suspected ones should be 
immediately slaughtered. No medical treatment should be thought 
of : such a course would be disastrous to both the individual owner 
and to the community. Sheds and stables in which the diseased 
animals have been kept are the most surely disinfected by burning. 
When so radical a method would prove too expensive, as it usually 
would, the building may be disinfected by sulphur fumigation on a 
large scale when the building can be made tight enough to hold the 
fumes. This fumigation should be ver}' prolonged and repeated sev- 
eral times at intervals, and then followed by prolonged and thorough 
airing-out. Hay and grain which has been in infected barns should 
be burned or fed to horses. 

Inoculation to prevent this disease has been practised considerably 
in some countries, but its efficacy is still disputed by eminent author- 
ities, and many facts and opinions which have been recorded, especially 
during the last few years, seem to prove that the disease ma^- some- 
times be spread b}' the inoculated animals. Inoculation, therefore, 
should not be permitted in our State. 

Tuberculosis. 

Tuberculosis or the "Pearl Disease" of cattle is essentially the same 
disease as human consumption. It is both contagious and hercditar}', 
but contagion, in animals at least, is a greater factor in its propaga- 
tion than heredity. Of the domestic animals, cattle and swine show 
the greatest predisposition to tuberculosis ; though others are liable 
to contract the disease when exposed to its infection. Undouljtedly 
the contagion is received into the system, in the natural way, almost 
always by inhalation or by swallowing ; experimentally, it is found 
that it may be communicated to man}' kinds of animals by inocula- 
tion and by other methods. The period which elapses Itetween the 
receipt of the infection and tlie ai)p('arance of the disease; is usually 
very long. The course of the disease varies greatly, the symptoms 
developing either rapidly or slowly ; hence we may have the disease 



CIRCULARS. 45 

lasting three months or less or extending over many months or years. 
In some cases it follows an insidious or concealed course, and quite 
extensive changes may occur in the lungs and other organs while j'et 
the animal suffers but little change in its external appearance. Us- 
uall}', however, it is seen that the animal is not benefited as he ought 
to be by his food. The appetite is often capricious, the skin looks 
dull and the hair dirty, cough maj- or may not be noticeable ; when it 
is, it is more likely to be after taking food or drink, or being hurried. 
Later in the course of the disease loss of flesh is marked, the cough 
becomes troublesome, and tliere is often diarrhoea. In cows the flow 
of milk may not be much diminished until the disease has lasted some 
time. 

The most characteristic appearance which is shown by a post mor- 
tem examination is that presented by the so-called "pearl tumors" or 
"grapes," as the butchers often call them. These tubercular new- 
formations vary in size from that of a pea or smaller to that of an 
egg. They are often confluent and one apparent mass may weigh 
several pounds, and the aggregate of these masses many pounds. 
These tubercles are found the most frequentl}- in the lungs and on 
the smooth membrane wMiich covers them ; they arc also often found 
on the membrane which covers the bowels. 

Between tuberculosis and pleuro-pneumonia there are man}- points 
of resemblance. Both are contagious, the period of incubation in 
tuberculosis is long and it may be in pleuro-pneumonia, fever and the 
lung symptoms are common to both, the disease in both often assumes 
a concealed form, dangerous to the remainder of the herd from the 
difficulty of its recognition. When either disease is suspected, the 
determination of its character should be made by the veterinary sur- 
geon. 

Feeding experiments have conclusively shown that tuberculosis 
may be transmitted by means of the milk or flesh of diseased animals. 
Therefore prevention has to regard both the danger to other animals 
and to man. The milk from cows with this disease, even in its earli- 
est stages or when suspected, should never be used as human food. 
The flesh should never be used unless the disease is in its earliest 
stages and is so localized that the tubercular growth can be entirely' 
removed ; even then, though it is not proved that the eating of such 
meat may give rise to the disease, there is a chance to doubt its 
wholesomeness and fitness as human food. As regards the animals, 
all diseased and suspected ones should be kept from other animals and 



46 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

the diseased ones slaughtered. Infected stalls and mangers should 
be disinfected, and the safer way would be to remove the woodwork 
of the cribs and eating boxes and replace them with new. 

Lung- Worm Disease. 

(Verminous Broxchitis ) . A disease caused by the development of 
a parasitic worm, the Strongyhcs micrurus in calves and the iStrongy- 
lusfilaria in lambs. Adult animals are sometimes infested. The 
symptoms presented are difficult}- of breathing, especially when hur- 
ried, cough, usuall}' hoarse and spasmodic, and in long continued 
cases debilit}' and emaciation. During the paroxysms of cough 
masses of mucus are sometimes discharged which contain eggs, em- 
br^'os and the adult forms of the parasite. The disease may prove 
fatal in a few days or may last from two to four months. Its nature 
is to be determined b}' an examination with a lens or with the naked 
eye of tlie mucus which is discharged from the mouth and nose, or 
in case of death, by an examination of the interior of the windpipe 
and bronchial tubes. The parasites are white, filiform worms, looli- 
ing very much like pieces of white thread, from one to two inches 
in lengtli according to the species witli wliich we have to do, and may 
be found rolled up in considerable masses, or may pretty completely 
plug up the smaller air tubes. Deaths following bronchial or lung 
symptoms in calves or lambs should lead to a post mortem examina- 
tion as to its cause. This trouble is more likely to be mistaken for 
pleuro-pneumonia or tuberculosis than for an}' other diseases. 

As the disease may be communicated from the sick to the well by 
means of water, fodder, or pastures wliicli have been contaminated 
with the parasites or their ova, all cattle or sheep suspected of having 
this disease should be careful!}' quarantined, and all known to have 
it should he slaughtered. The lungs and other parts containing the 
parasites, as well as an}' mucus coughed up, should be destroyed with 
fire. The ova, with which many of the parasites are filled, are hard 
to kill with chemicals. 

Swine Plague. 
This disease, or "hog-cliolera," as it is commonly calle.(l, is an in- 
fectious disease which has been tcrril)ly destructive of swine in some 
parts of this country : in Illinois alone over three and a half million 
hogs were lost l)y it in the years 1877-8-0. The contagi(jn of this dis- 
ease is very easily diffusible, more so than that of mostother contagious 



CIRCULARS. 47 

diseases of animals. It may be communicated directly from animal 
to animal, or indirectly by other animals which are not affected, or by 
means of the clothing of visitors, and there are reasons to believe that 
it may be spread by the wind. It is communicable to other animals 
than swine, — dogs, cats, Iambs, mice, and chickens, — and from these 
it may be communicated again to hogs. In fatal cases the disease 
ma\' last from a few hours to three or foiu* weeks. In ordinary cases 
the brunt of the attack falls upon the lungs and larger intestine; 
therefore when a post-mortem examination is made the lungs are 
often found inflamed and more frequentl}' the lining of the large in- 
testine is found inflamed or ulcerated. 

The most characteristic symptoms are great debility, want of ap- 
petite, or vitiated appetite for excrement, drooping of the ears and 
of the head, a tendency to bury the nose or the head in the bedding, 
rapid emaciation, weak and undecided and often staggering gait, very 
ofifensive smell, especiall}' in severe cases before and after death, and 
rapid decomposition of the body after death. Most characteristic, 
however, is the diarrhoea, with fetid and usually dark colored dis- 
charges. Instead of the diarrhwa, there is often constipation, es- 
pecially early in the disease. Cough is a symptom when the lungs 
are affected. 

To prevent the spread of the disease, separate the well from the 
sick. Avoid all the methods of spreading the contagion which are 
indicated above. Do not be in too great haste to refill the stj-, for 
the freezing of winter will often fail to eradicate the infection from 
the premises. The '•'RoiKjet" of France is probably not identical 
with the swine-plague of America, therefore it is not prudent to em- 
ploy here the method of inoculation which lias been used for the 
former disease. 

Trkliinosis. 

The much written-about trichinosis of man is caused by eating 
pork containing trichinw. Tiiese are small parasitic worms, from 1-8 
to 1-18 of an inch in length, encysted in the red or lean part of the 
meat. They are detected with difliculty with the unaided e^-e, but 
are readily discoverable, when present, by means of the microscope. 
These parasites, being oaten by man or animals in raw or partiall}" 
cooked pork, are liberated from their capsules by the process of 
digestion, and then rapidly multiply. The innumerable multitude of 
the new progeny fortiiwith take up their line of march from the 



48 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

digestive tract, penetrating all the intervening tissues, until they reach 
the muscles in the various parts of the body. 

Here they become encysted as the parent trichinffi were in the meat 
which was eaten. The symptoms caused by the migration of the 
trichinj>? and their fixation in the substance of the muscles are 
feverishnoss, sudden swelling of the face, swelling of the muscles all 
over the bod>', muscular pains and lameness, usually diarrha'a. 
These symptoms have considerable likeness to those of typhoid fever 
and rheumatism, and the trichinous disease has undoubtedly some- 
times been mistaken for these. The symptoms of trichinous infection 
in animals are less severe but resemble somewhat those in man. 
To prevent human infection one precaution only is needed, — cook the 
pork thoroughly. 

Foot-and- Mouth Disease. 

Though rarel}' fatal, this disease is said to have caused nearly as 
much loss and trouble to the farmers of Great Britain as the conta- 
gious pleuro-pneumouia. It is contagious in a high degree ; when 
introduced into a flock or herd but few of the exposed animals escape. 
It affects principally cattle, sheep and swine, but raa}^ be communi- 
cated to other animals, and to man by direct contagion or by using the 
railk from diseased cows. The contagion is not readily diffusible 
through the air, but is spread by means of direct contact, and by 
means of food, watering-troughs, litter, grounds and roads with which 
the diseased animals have come in contact, or it may be carried from 
animal to animal through the medium of infected hands or clothing. 

The period of incubation, that is, the length of time between 
exposure to the contagion and the outbreak of the disease, is usually 
two or three days but may be only one day or ma^^ be as long as ten 
or twelve days. After 24 or 48 hours of feverish symptoms, the 
characteristic eruption appears in the mouth and on the feet, and often 
on other parts of the body, particularly where the skin is not thickly 
covered with hair. As seen in the mouth, the eruption at first con- 
sists of whitish or j'ellowish l)listers varying in size from that of a 
mustard seed to that of a bean. On the feet we find heat, redness, 
and swelling around the edge of the hoofs and especially towards the 
heel and in the space between the toes, followed in one or two days by 
the blisters at these points. After the rupture of these vesicles, 
bright red and very tender ulcers are left, and l)y the coalescence of 
the vesicles these ulcers are often of considerable extent. The sore- 



CIRCULARS. 49 

ness of the month makes it impossible for the animals to take their 
accustomed food, and in the feet the pus may burrow and cause the 
loss of the hoof. This is not likely to be confounded with anj' other 
disease except the " Foot-Rot " of sheep and with " Ergotism " which 
has appeared in some of the States. In these diseases there are no 
mouth symptoms. 

Very strict measures should be put in force to prevent the spread 
of the disease. Diseased animals should be isolated and guarded 
carefully. Persons not having the care of them should not be 
permitted to visit them, and the attendants should not visit other cat- 
tle, sheep, or swine. No sick animal must be permitted on roads or 
grounds where other animals may go. Food or bedding must not be 
moved from the infected premises and manure must be burned or 
plowed in on the infected farm. Grounds on which infected animals 
have run should be plowed with horses. The sale or use of infected 
milk should be striclh' prohibited. A thorough cleansing and disin- 
fection of everything infected should be followed b}' prolonged airing- 
out. 

Foot-Rot in Sheep. 

This disease begins with an inflammation of the interdigital spaces 
and is followed b}' a swelling which may extend all the way around 
the edge of the hoof, and this inflammation soon runs on to suppuration, 
burrowing of pus, and may lead to separation of the hoof. The dis- 
charge is purulent, very offensive, and is the medium for transmitting 
the disease to other flocks. This disease may be spread rapidly from 
animal to animal or from flock to flock until it becomes ruinous to the 
sheep-raising industry where it exists. It should not be confounded 
with the foot and mouth disease previously described. 

Preventive treatment should consist in isolating all affected sheep 
and keeping all healthy ones away from them. Diseased animals 
must not be transported from place to place. 

Sheep-Pox. 

A contagious, eruptive disease of sheep resembling considerably 
human small-pox, and probably having some relationship to it. Dur- 
ing some epizootics of this disease it has proved itself to be one of 
the most destructive of animal pests. It ma}' be communicated to 
other animals. As in the allied disease in man, prompt isolation and 



50 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

"vaccination" have been found to be the two effective measures to be 
employed. 

Anthrax. 

(Carbuncle; Splenic Fever ; Malignant Pustule ; Charbon.) 
— This disease has prevailed but little in New England, but in some 
countries it has been a veritable scourge to the husbandman, attacking 
cattle, horses, sheep, and quite frequently other animals and man. 
Sixty or seventy per cent of the animals attacked die. The period of 
incubation is short, from a few hours to three or four da3's. The 
symptoms vary so much in different cases that no concise descriptiou 
of them can be given. The apoplectic form ma}' kill in a few min- 
utes or in several hours, the acute in a few hours or days, and other 
forms are slower in their course. There is usually evidence of severe 
blood poisoning, trembling, difficulty of breathing, dark purplish color 
of the mucous membranes, spasms or convulsions, coldness of the 
extremities, and death. After death the blood is often found dark and 
tarry, and dark, serous, or semi-gelatinous infiltrations are frequent. 
This disease is intensel}' contagious. Malignant pustule, the same 
disease, has often been communicated to man by handling wool or 
hides from animals which have had anthrax, and the disease may be 
carried from one animal to another by the bites of flies. 

Preventive measures include strict quarantine of sick animals, imme- 
diate destruction with fire of the carcasses of the dead, or, when this 
is impracticable, ver}' deep burial with fencing of the place to keep 
other animals from the spot, and very thorough disinfection of every- 
thing possibly contaminated. 

Babies. 

Rabies, or Hydrophobia when it appears in man, is never gener- 
ated spontaneously ; but is due to inoculation by means of bites or 
otherwise from other rabid animals, usually carnivorous. In the dog, 
•there is an incubative period from three to six weeks after the bite 
is received before the first symptoms appear. The earliest symptoms 
consist in but little more than a change in the disposition and manners 
of the animal, witii loss of appetite or sometimes a disposition to eat 
indigestible or repulsive substances. Later there comes the stage of 
excitement, during which the dog shows a tendency to range at large, 
attacking other animals as he goes. After a period of from four to 
eight days, death closes the scene with the paralytic or exhaustive 



CIRCULARS. 51 

stage. In some cases, — the "dumb" or "torpid" form of the disease, 
— the paralytic symptoms come on early. These cases are marked 
by the "dropping" of the lower jaw, thus rendering the animal unable 
to bite or bark. There is in this disease no fear of water, but there 
is a difficulty or inability to drink it. It is believed that many cases 
of so-called hydrophobia in man are due to the mental effect of the 
receipt of the bite. Therefore, for the sake of the peace of mind of 
such, the dog should not be killed, if he can be secured without dan- 
ger to other persons. If he does not die within six or eight days it 
may be known that he was not rabid. If he should die, however, 
he ma}- not have been rabid, but ma}- have died of some other disease. 
Only the skilled veterinary or medical authorit}- should decide this. 
The question regarding the protective power of Pasteur's anti-rabic 
inoculation is not yet decided to the satisfaction of most physicians. 
Not more than half the persons l)itten by rabid dogs have the disease, 
and of those bitten by suspected dogs not more than eight or ten per 
cent have hydrophobia. 

Fmol- Cholera. 

The characteristic symptoms are: "Drooping of the wings, an 
unconquerable somnolence, on startling the animals and forcing them 
to open their eyes, they seem to wake as from a deep sleep, and soon 
the lids close again, and usually death occurs without an}' particular 
movements of the animal, and after a mute agony ; at most its wings 
flutter a little as it dies." 

The contagion of the disease is not diffusible through the air but 
seems to be quite fixed. It passes off from the diseased bird by means 
of the excrement, and infects other fowls by being taken into the body 
in the food and drink. 

To prevent the disease, remove the infected droppings daily and 
disinfect the floor or ground. Remove promptly the diseased birds 
from the unaffected ones. Pasteur's inoculation for this disease has 
proved successful. 

Gcqoes. 

A disease of fowls caused by a parasitic worm, Symjnmus trachealis, 
in the wind-pipe. This worm is of a red color, half an inch or more 
in length, forked or branched like a rudely drawn letter "Y," and 
attached to the mucous membrane of the bird's wind-pipe by means of 
suckers at the ends of the two upper branches of the "Y." The symp- 



52 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

toms fire sneezing, coughing, suffocation and death. Suspicions of the 
nature of the disease may by verified occasionally by the bird's cough- 
ing up the worms, or by opening the wind-pipe. The life-historj' of 
the parasite briefly is this : The matured worm is full of eggs, and 
these, after the death of the parent, when falling upon moist ground 
or in water, hatch, and food, water, or earth-worms, infested with 
these minute larvaj, may carry them into the crops of healthy birds ; 
or the syngami coughed up, ma}' be seized and swallowed. From the 
digestive tract they make their way to the lungs and ultimately into 
the wind-pipe. 

Preventative measures are obviously the keeping of healthy birds 
from the sick, and from infected grounds. Burn all syngami found. 
Burn or bury deeply all dead fowls. Infected grounds may be treated 
liberally with salt, lime, ashes, or chemicals. 

Actinomycosis. 

A contagious tumor affecting the head and face of cattle, which until 
lately was considered to be cancerous or tubercular in its nature. It 
is caused b}' infection with a microscopic fungoid plant. It may be 
transferred to man and other animals. 

Diphtheria. 

It is known to medical men and veterinarians, but not to the general 
public as it should be, that diphtheria is a disease of the domestic 
animals as well as a human disease. It has been known to prevail 
quite extensivelj' and with fatal effect among cats, dogs, pigs, poultr}' 
and other animals. It is thought by some that many local outbreaks 
of this disease among children are referable to its prior existence in 
animals. In some cases the truth of this supposition has been 
verified. 

Cattle- Plague. 

(Rinderpest.) — This disease in 1865-6, in eighteen months, de- 
stroyed 000,000 cattle in Groat Britain. When once it invades a 
country, unless prompt and vigorous stamping-out measures are 
employed, its extreme contagiousness makes its spread over the land 
rapid, and its malignancy is so great that most of the cattle attacked 
die. The period of incubation is very short, and is followed bj- fever, 
an eruption on the mucous membrane of the mouth, and often a 



TREATMENT OF THE DRO^VNED. 



53 



salmon-red or purple color of the mucous membranes. "Then ensue 
the urgent symptoms, — the drooping head, hanging ears, distressed 
look, rigors and twitcliings of the superficial muscles, failing pulse, 
oppressed breathing, fetid breath, and the discharge from the nose, 
eyes and mouth." 

Prompt slaughter of all diseased and suspected animals, thorough 
disinfection, and rigid quarantine of infected places, — nothing short 
of this is of any avail. 

TREATMENT OF THE DROWNED. 



Two Things to be Donk 



Restore Breathing ; Restore Animal 
Heat. 



Rule 1. Remove all obstructions to breathing. Instantly loosen 
or cut apart all neck and waist bands ; turn the patient on his face, 
with the head down hill ; stand astride the hips with your face towards 
his head, and, locking your fingers together under his belly, raise the 
body as high as you can without lifting the forehead off the ground 
(Fig 1), and give the body a smart jerk to remove mucus from 
the throat and water from the windpipe ; hold the body suspended 
long enough to slowly count one, two, three, four, five, repeating the 
jerk more gentW two or three times. 




54 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 




Rule 2. Place the patient face downward, and maintaining all the 
while your position astride the body, grasp the points of the shoulders 
by the clothing, or, if the body is naked, thrust your fingers into the 
armpits, clasping your thumbs over the points of the shoulders, and 
raise the chest as high as you can (Fig. 2) without lifting the head 
quite off the ground, and hold it long enough to slowly count one, 
two, three. Keplace him on the ground, with his forehead on his flexed 
arm, the neck straightened out, and the mouth and nose free. Place 
your elbows against your knees and your hands upon the sides of his 
chest (Fig. 3) over the lower ribs, and press downward and inward 
with increasing force long enough to slowly count one, two. Then 
suddenly let go, grasp the shoulders as before and raise the chest 
(Fig 2) ; then press upon the ribs, &c. (Fig. 3). These alternate 
movements should be repeated 10 to 15 times a minute for an hour 
at least, unless breathing is restored sooner. Use the same regularity 
as in natural breathing. 



--.^'^1 




TREATMENT OF THE DROWNED. 55 

Rule 3. After breathing has commenced, restore the animal heat. 
Wrap him in warm blankets, apply bottles of hot water, hot bricks, or 
anything to restore heat. Warm the head nearbj as fast as the body, 
lest convulsions come on. Rubbing the body with warm cloths or the 
hand, and slapping the flesh}' parts may assist to restore warmth, 
and the breathing also. If the patient can surely swallow, give hot 
coffee, tea, milk, or a little hot sling. Give spirits sparingh', lest they 
produce depression. Place the patient in a warm bed, and give him 
plenty of fresh air ; keep him quiet. 

Beware. 

Avoid delay. A moment may turn the scale for life or death. 
Dry ground, shelter, warmth, stimulants, etc., at this moment are 
nothing, — artificial breathing is everything, — is the one remedy, — all 
others are secondary. 

Do not stop to remove wet clothing before efforts are made to 
restore breathing. Precious time is wasted, and the patient may be 
fatally chilled by the exposure of the naked bodv, even in the sum- 
mer. Give all your attention and effort to restore breathing by 
forcing air into and out of the lungs. If the breathing has just 
ceased, a smart slap on the face, or a vigorous twist of the hair will 
sometimes start it again, and may be tried incidentally, as ma}', also, 
pressing the finger upon the root of the tongue. 

Before natural breathing is full}- restored, do not let the patient 
lie on his back unless some person holds the tongue forward. The 
tongue by falling back may close the windpipe and cause fatal 
choking. 

If several persons are present, one ma}- hold the head steady, 
keeping the neck nearly straight ; others may remove wet clothing, 
replacing at once clothing which is dry and warm ; they may also 
chafe the limbs, and thus promote circulation. 

Prevent friends from crowding around the patient and excluding 
fresh air ; also from trying to give stimulants before the patient can 
swallow. The first causes suffocation ; the second, fatal choking. 

Do not give up too soon. You are working for life. Any time 
within two hours you may be on the very threshold of success with- 
out there being any sign of it. 

In suffocation by smoke or any poisonous gas, as also by hanging, 
— proceed the same as for drowning, omitting effort to expel water, 
etc., from the windpipe. 



56 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

In suspended breathing from effects of chloroform, hydrate of 
chloral, etc., proceed by Rule 2, taking especial pains to keep the 
head very low, and preventing closure of the windpipe by the tongue 
falling back. 

The foregoing method, originally published by the State Board of 
Health of Michigan, has the sanction of other State and City Boards 
of Health, and is fully endorsed by the State Board of Health of 
Maine, and printed for general distribution as a life-saving measure. 

Address State Board of Health, Augusta. 

LIBRARY. 

The collecting of a useful working librar}^ for the Board is an 
important matter which has been constantly borne in mind, and the 
result is that we have already a pretty respectable collection of home 
and foreign sanitary literature in the library. The collection has been 
made largely through exchanges with other health organizations, local, 
State and national. Some valuable and indispensable works which 
cannot be so procured it has been necessary to get by purchase. 
The following list includes the works which are now in the library 
and also a few which have been loaned for the use of the Board. 

Reports and Other Publications of Boards of Health. 

National Board of Health, Annual Report, 1879, 1880, 1881, 1882, 

1883, 1884, 1885. 

The Local Government Board, England, Annual Report, 1882, 1883, 

1884, 1885, 1886. 

, Model By-Laws, 15 Pamphlets. 

Mittheilungen aus dem Kaiserlichen Gesundheitsamte, Berlin, Vols. 

I and II. 
Arbeiten aus dem Kaiserlichen Gesundheitsamte, Berlin, Vol. I. 
Ontario, Annual Report, 1882, 1883, 1884, 1885. 
Disinfectants. 

Preventable Disease Circulars. 
New Hampshire, Annual Report, 1882, 1883, 1884, 1885, 1886. 

Disinfectants and their use. 
Massachusetts, Annual Report, 1870, 1871, 1872, 1873, 1874, 1875, 
1870, 1877, 1878, 1879, 1882, 1883, 1884, 1885. 
Public Health Statutes, Manual, 
(^luility of Milk in Massachusetts. 
Preventive Disease Circulars. 



LIBRARY. 57 

Rhode Island, Annual Report, 1877, 1879, 1882, 1883, 1884, 1885. 

Asiatic C'iiolera. 
Connecticut, Annual Report, 1884. 
On Disinfection, 1884. 
Preventable Disease Circulars. 
Registration Laws. 
Suggestions on Rural Hygiene. 
State Preventive JNIedicine. 1879. 
New York, Annual Report, 1880, 1881, 1882, 1883, 1884, 1885. 

Manual of Public Health Laws. 1880. 
New Jersey, Circulars. 

School and Health Circular. 
Health Counsels for Working People. 
Protection to Bathers. 
Contagious Diseases of Animals. 
Petroleum, Kerosene, etc. 
]\Iairiages, Births and Deaths, 1878. 
Pennsylvania, Annual Report, 1885. 

Constitution and By-Laws. 
Delaware, Annual Report, 1883, 188,5. 

Domestic Hygiene and Quarantine. 
Maryland, Annual Report, 188G. 
West Virginia, Report, 1884. 
North Carolina, Report, 1884. 

Prevention of Diphtheria. 
Post Mortem P^xaminatious. 1879. 
South Carolina, Report, 1885, 1886, 
Mississippi, Report, 1882, 1883. 
Tennessee, Report, 1877-80, 1880-84. 

Preventable Disease Circulars. 
Bovine Tuberculosis. 
Sanitary' Propositions. 
Vital Statistics in Tennessee. 
Prisons and Public Charities, 1878. 
Indiana, Report, 1882, 1883, 1884, 1885. 

Rules, Regulations and Suggestions. 
Illinois, Ri'port, 1870, 1880, 1881, 1882, 1883, 1884, 1885. 
Register of Physicians, 1884. 
Conspectus of Colleges, 1884. 
Preventable Disease Circulars. 



58 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

Illinois, Proceedings of Sanitary Council, 1885. 
Various Reports of Proceedings. 
Public Health Laws, 1884. 
State Sanitary' Surve}', 1885. 
Michigan, Report, 1873, 1874, 1875, 1876, 1877, 1878, 1879, 1880, 
1881, 1882, 1883, 1884, 1885. 
Preventable Disease Circulars. 

Prevention and Restriction of Contagious Diseases. 
Wisconsin, Report, 187G, 1877, 1878, 1879, 1880, 1881, 1882, 
1883, 1884, 1885. 
Preventable Disease Circulars. 
Infant Mortalitv. 

Local Boards of Health, Powers and Duties. 
Minnesota, Report, 1812-82, 1883-84. 
Contagious Diseases. 

Minnesota from the Standpoint of Public Health. 
Iowa, Report, 1881, 1883, 1885. 

Preventable Disease Circulars. 
Contagious Diseases in the Public Schools. 
The Typhoid Fever of America. 
Rules and Regulations for Local Boards of Health. 
Illuminating Oil. 
Health Laws. 1883. 
Geology and Topography. 
Diseases of Animals. 1885. 
Registration Report, 1883. 
Kansas, Report, 1885. 

State and Local Boards of Health. 
California, Report, 1870-71, 1871-73, 1874-75, 187G-77, 1877-79, 
1879-80, 1880-81, 1882-83. 

Other Reports. 

Surgeon-General of the Navy, 1879, 1880, 1881, 1884. 
Secretary of the Navy, 1882, 1883, 1884. 
Massachusetts l^rainage Commission. 
Last Two Ciiolera Epidemics of London, 1856. 
Cholera P^pidemic of 1866 in England. London. 
Commissioner of Education, 1H84, 1H85. 
Hygienic and Medical Reports, U. S. N., 1879. 
Department of Agriculture, 1881-82, 1884, 1885. 



LIBRARY. 59 

New York State Dairy Commissioner, 1886. 
Cliolera in Europe iu 1884. 
Cholera Epidemic of 1873 in U. S. 

Rkports of Local Boards of Health. 

Hartford, Connecticut, 1886. 
New Haven, " 1882. 

Boston, Massachusetts, 1884, 1885. 
Fall River, " 1885. 

Franklin, New Hampshire, 1884, 1885. 
Providence, Rhode Island, 1884. 
Augusta, Maine, 1885. 
Burlington, Vermont, 1882. 
Newark, New Jersey, 1885. 
Cleveland, Ohio, 1881. 
Detroit, Michigan, 1883. 
Kansas City, Missouri, 1882. 
Atlanta, Georgia, 1884. 
Charleston, South Carolina, 1882. 
Memphis, Tennessee, 1881, 1882. 
San Fiancisco, California, 1884. 
Oakland, " 1885. 

Public Health in General. 

Parkes, Practical Hygiene. Philadelphia, 1883. 

De Chaumont, Lectures on State Medicine. London, 1875. 

Fothergill, Maintenance of Health. New York, 1874. 

Wight, Maxims of Public Health. New York, 1884. 

Simon, Filth Diseases and their Prevention. Boston, 1876. 

Smith, Foods. New York, 1884. 

Kingsley, Health and Education. New York, 1884. 

liil)le Hygiene. Philadelphia, 1880. 

Reports of the American Public Health Association, Vols. I, II, 

III, IV, V, VI, VII, VIII, IX, X, XI. 
Prize Essays of the American Public Health Association. 1885. 
Gardner, Homes and How to Make Them. Boston. 1874. 
Carter, Good and Bad Eyesight. Philadelphia, 1882. 
American Health Primers. Philadelphia, 1885. 

Lincoln, School and Industrial Hygiene. 

Cohen, The Throat and the Voice. 



60 STATE BOAED OF HEALTH — SECRETARY'S REPORT. 

"Wilson, The Summer and its Diseases. 

Osgood, Winter and its Dangers. 

Richardson, Long Life and How to Reach It. 

Harlan, E^'esight and How to Care for It. 

Wood, Brain-work and Over-work. 

Packard, Sea-Air and Sea-Bathing. 

Bulkley, The Skin in Health and Disease. 

White, Tiie Mouth and the Teeth. 

Burdett, Hearing and How to Keep It. 

Hartshorn, Our Homes. 
Corfield, Dwelling Houses. New York, 1880. 
Farr, Vital Statistics. London, 1885. 
Nightingale, Notes on Nursing. 
Tracy, Handbook of Hygiene. 

Drainage and Sewerage. 

Waring, Drainage for Profit and Health. New York, 1884. 

, The Sanitary Drainage of Houses and Towns. Boston, 1884, 

French, Farm Drainage. New York, 1884. 

Gerhard, House Drainage and Sanitary Plumbing. New York, 1884. 

, Drainage aud Sewerage of Dwelliugs. New York, 1884. 

Corfield, Sewerage and Sewage Utilization. New York, 1875. 
Staley and Pierson, The Separate System of Sewerage. New York. 
Putnam, The Principles of House Drainage. Boston, 1886. 
Fox, The Disposal of the Slop Water of Villages. London, 1877. 
Pbilbrick, American Sanitary Engineering. 

Water and Water Supply. 

MacDonald, Water Analysis. London, 1883. 
Nichols, Filtration of Potable Water. New York, 1879. 
Corfield, Water and AVater Supply. New York, 1875. 
Frankland, Water Analysis. Philadelphia, 1880. 

Heating and Ventilation. 

Billings, Ventilation and Heating. New York, 1884. 

Morin, Warming and Ventilating Buildings. Washington, 1882. 

Bacteriology and Microscopy. 

Hueppe, Methods of Bacteriological Investigation. New York, 
1886. 



LIBRARY. 61 

Crookshank, Practical Bacteriolog}'. New York, 1886. 

Friedlitnder, Use of the Microscope. New York, 1885. 

Sternberg, Bacteria. New York, 188'Jl. 

, Photo-Micrographs and How to Make Them. New York, 

1884. 

Beale, How to AVork with the Microscope. Philadelphia, 1880. 

Martin, Manual of Microscopic Mounting. London, 1878. 

Bausch, Manipulation of the Microscope. Rochester, 1885. 

Sedgwick and Wilson, Biologj'. New York, 1886. 

Frey, Das Mikroskop und die Mikroskopische Technick. Leipzig, 
1870. 

Black, The Formation of Poisons by Micro-Organisms, Philadel- 
phia, 1884. 

Gradle, Bacteria. Chicago, 1883. 

Thumen, Die Bacterien im Haushalte des Menschen. Vienna, 1884. 

Veterinary Science. 

Billings, Animal Diseases. New York. 1884. 

Lydtin, Fleming and Van Hertsen, Propagation of Tuberculosis. 

London, 1884. 
WalW, The Four Bovine Scourges. Edinburgh, 1877. 
Diseases of Swine and Other Animals. Washington, 1879. 
The Journal of Comparative Medicine and Surgery. Vols. I, II, 

HI, IV, V, VI, VII. 
Bollinger, Zur Aetiologie der Tuberkulose. Munich, 1883. 
Johone, Athmung, Athmungsluft, und Luftverderbuiss. Berlin, 

1884. 

School-Hodses and School Hygiene. 

Lincoln, School and Industrial Hygiene. Philadelphia, 1880. 
Baginsky, Handbuch der Schulhygicne, Stuttgart, 1883. 
Whitford, Plans and Specifications of School-Houses for Wisconsin. 

Madison, 1882. 
Education Department of Ontario, School Architecture and Hygiene. 

Toronto, 1886. 
Board of Education of New Brunswick, Plans of School-Houses, 

with Specifications. Fredericton, 1872. 
Manual of the School Law of New Brunswick. Fredericton, 1880. 
Henderson, Manual of Kentucky School Architecture. 1876. 
Report on School Architecture, with Plans. Washington, 1870. 
Chase, School-Houses and Cottages. Washington, 1868. 



62 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

Bureau of Education, Rural School Architecture. 1880. 

Rules to be observed in Planning aud Fitting up Schools. London, 

1883. 
Report of the Minister of Education, South Australia. Adelaide, 

1886. 
"Weber, Ueber Schul-H3'giene in England. Wiesbaden, 1884. 
Planat, Construction et Amenagement des Salles d'Asile et des 

INIaisous d'Ecole. Paris, 1881. 
Plans-Modeles pour la Construction des Salles d'Asile. Paris, 1861. 
Planat, Nouveau Reglement pour la Construction et 1' Ameublement 

des Eeoles Priraaires. Paris, 1881. 
Narjoux, Les Eeoles Normales Primaires, Paris, 1880. 
Nonus, Les Batiments Scolaires. Paris, 1883. 
Riant, Hygiene Scolaire, Paris, 1882. 
Wettstein, Unterrichtswesen. Zurich, 1884. 
Linsraayer, Die Munchener Schulbank. Munich, 1876. 
Bericht der Koramission lUr Schulbau-Normalien ueber die Mog- 

licbkeit von Ersparnissen beim Bau vou Primar-Schulhausern. 

1885. 
Program fUr den Bau von Schulhausern in Munchen. 
Bericht der Koramission fiir Schulbaunorraalien an den Regier- 

ungsrath des Kantons Basel-Stadt. 1882. 
Inspection Hygienique and Medieale des Eeoles. Antwerp, 1882. 
Reglement op de Ongezonde Woningen. Antwerp, 1884. 
Verordnungsblatt fiir das Volksschulwesen im Konigreiche Bohem 

Stunk VII. Prague, 1873. 
Bongioannini, Gli PMifizi per le Scuole Primarie. Rome, 1879. 
Ministero Delia Pubblica Istruzione, BoUettino Ufhciale. Rome, 

Seven Numbers. 
Fifteen Plates giving plans for School-Buildings from Amsterdam. 
Notizen uel)er die neuern Schulgebaude in Basel. 
Plans of Three South Australian School Buildings. Traced for the 

State Board of Health of Maine by the Superintendent of Public 

liuildings, Adelaide, South Australia. 
Verfiigung des K. Miuisteriums des Kirchen und Schulwesens. 

Stuttgart, 1870. 
South Australia Education Department, Acts and Regulations. 

1885. 
Lincoln, Hygiene of Public Schools in Massachusetts. Boston, 1879. 
Randall, Book of Designs for School-Houses, Chicago, 1884. 



LIBRARY. 63 

Briggs, Suburban School-Houses. Concord, 1882. 
Monroe, Physical and Vocal Training. Philadelphia, 1870. 
Richey, Vision in School Children. Concord, New Hampshire, 1885. 
Robertson, Over-Pressure in Schools. Des Moines, 1885. 
Bureau of Education, Causes of Deafness among School Children, 

1881. 

, Effects of Student Life upon the Eyesight. 1881. 

, English Rural Schools. 1880. 

Reglement pour la Construction et I'Ameublement des Maisons 

d'Ecole. Paris, 1880. 
Regulations for the Public Schools, Charlottetown, P. E. I., 1886. 

Miscellaneous. 

Library of Surg.-General's Office, Index Catalogue. Vols. T, II, 

III, IV, V, VI, VII. 
Webster's Dictionary. 
Quain, Dictionary of Medicine. 

Cutter, Dictionary of German Terms. New York, 1880. 
Foster and Langley, Practical Physiology. London, 1884. 
Foster, Text Book of Physiology. Philadelphia, 1885. 
Hinton, Physiology for Practical Use. New York, 1874. 
Walker, Physiology and Hygiene. New York, 1885. 
Martin, The Human Body. New York, 1885. 
Tracy, Anatomy, Physiology and Hygiene. New York, 1884. 
Hutchinson, Physiology and Hygiene. ' New York, 1885. 
Steele, Hygienic Physiology. New York, 1884. 
Mills, Physiology and Hygiene. Philadelphia, 1885. 
Emergency and Hygiene Association, School Hygiene. Boston, 

1885. 
Smith, The Human Body and Its Health. New York, 1885. 

, Primer of Physiology and H3'giene. New York, 1885. 

Fothergill, Animal Physiology. New York, 1881. 

Dunglison, F^lementary Physiology. Philadelphia, 1885. 

W. N. C. T. U., Hygiene for Young People. New York, 1885. 

Johonnot and Boton, How We Live. New York, 1885. 

Buckolew and Lewis, Practical Work in the School-Room, N. Y., 

1885. 
Brands, Lessons on the Human Body. Boston, 1883. 
Jncobi, Infant Diet. New York, 1885. 
Shepard, Inorganic Chemistry. Boston, 1885. 



64 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

Richards, Food Materials and Adulterations. Boston, 1885. 

Clapp, Is Consumption Contagious? Boston, 1882. 

Burdett, Cottage Hospitals. London, 1880. 

Jaccoud, Pulmonary Phthisis. New York, 1885. 

Foster, Vaccination. Concord, 1884. 

Hunt, Principles of H^-giene. New York, 1886. 

Harrison, Legislation on Insanity. Philadelphia, 1884. 

Sattler, Tuberculosis. Cincinnati, 1883. 

Almquist, AVie Entstehen uusere Masernepidemien ? Goeteborg, 

1885. 
Braus, Die Diphtheric. Essen a. d. Ruhr. 
Colby, Atlas of Maine. 1884. 
Revised Statutes of Maine. 1883. 
Laws of jNIaine, 1885. 
Public Health Acts. London, 1886. 
Varney, Gazetteer of Maine. Boston, 1886. 
Eulenburg, Real-Enc3'clopadie der Gesamten Heilkunde. Vols. I 

to XV, inclusive. Leipzig, 1883. 
Transactions of the Maine Medical Association, 1853-62, 1866-68, 

1871, 1872, 1873, 1874, 1875, 1877, 1878, 1879, 1880, 1881, 

1882, 1883, 1884. 
Saunders, Disposal of Refuse by Cremation. London, 1881. 

Journals. 

Sanitary Engineer, New York, Vols. XII, XIII, XIV. 

Sanitarian, New York, Vols. I, II, III, IV, V, VI, VII, VIII, IX, 
X, XI, XII, XIII, XIV, XV, XVI, XVII. 

Sanitary News, Chicago, Vols. I, II, III, IV, V, VI, VII, VIII. 

Building, New York, Vols. IV and V. 

Sanitary Record, London, Vols. VII and VIII. 

Deutsche Vierteljahrssohrift fiir offentliche Gesundheitspflege, Ber- 
lin, Vols. XVI, XVII, and XVIII. 

Revue D'llygiene, Paris, Vols. VII and VIII. 

Annals of Hygiene, Vol. I. 

Nebraska Farmer, Vol. X, Nos. 16, 17, 18, 19, 20, 21, 22, 23, 24. 

American Monthly Microscopic Journal, Washington, Vols. VI and 

vn. 

Zeitschrift fur Hygiene, Leipzig, Vol. I, Nos. 1 and 2. 
Medical Record, New York, Vols. XXIX, XXX. 



LIBRARY. 65 

Boston Medical and Surgical Journal, Vols. LXXXIII to CXII 

(inclusive). 
United States Governnoent Publications, Vols. I and II. 
Public Health in Minnesota, Vol. II. 

Pamphlets. 

Watson, Water Pollution — Wells. 

Crosby-, Water Pollution. 

Baker, Typhoid Fever. 

Conn, Ventilation. 

Hull, Ventilation. 

School Hygiene. 

Hart, The Truth about Vaccination. 

Watson, Common Law Citations. 

Bartlett, Adulteration of Food. 

Gallinger, The Religion of Health. 

Robertson, Sanitar}- Science and Public Hygiene. 

Holt, The Sauitar}- Protection of New Orleans. 

History of Vaccination Controversy in Rock Island, 

Gerrish, The Sanitary Condition of Portland. 

Hueston, Sanitary Progress in Michigan. 

How to make Photographs. 

Fulsom, Public Schools and Disorders of the Nervous System. 

Angcll, Sanitary Examination of Drinking Water. 

Cliaillc, Small-Pox and Vaccination. 

Provincial Board of Health, Instructions to Vaccinators. 

Memorial of the Dedication of the Public Latin and English High 

School-House, Boston. 
Ladies' Sanitar}' Association, London, 26th An. Rpt. 

, Tracts and Pamphlets. 

Australian Health .Society, Tenth Annual Report. 

, Tracts and other Publications of. 

National Health Society, London, Thirteenth Annual Report. 

Citizen's Sanltar}' Society, Brooklyn, Tracts and Circulars. 

New Orleans Auxiliary Sanitary Association, Various Pamphlets. 

The Worcester Sewage and the Blackstone River. Boston, 1882. 

Sternberg, Diagnosis of the Yellow Fever. 

Andrews, Lighting and Seating School-Houses. 

Parish, Study out of School Hours. 

5 



Q6 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

Bureau of Education, Various Pamphlets. 

Proceedings at Sanitary Conventions in Michigan. Various 
Pamphlets. 

Thompson, Address at Detroit. 1883. 

Wight, Laws Requiring Medical Men to Report Deaths and Infec- 
tious Diseases. 

Anagnos, Kindergarten and Primary School for the Blind. 

Kedzie, Health Homes for Farmers. 

Farquharson, Hospitals for Contagious Diseases. 

Lindsle}', Prevailing Methods of Sewage Disposal. 1880. 

Philbrick, The Disposal of Sewage in Suburban Residences. 1883. 

Preliminary Report of the Committee on Disinfectants. 

Registration Laws of New Brunswick. 

Holt, The New Quarantine S3'stem. New Orleans, 1885. 



EXPENSES OF THE BOARD. 

The amount and character of the expenditures of the Board for 
the year 1886 were as follows : 

Engraving and drawing $7 61 

Books and sanitary journals 79 90 

Instruments 25 85 

Paper and stationery 49 44 

Postage 194 GO 

Printing and binding 176 20 

Secretary's salary 2,000 00 

Expenses of members 156 90 

Express and telegraph 41 66 

Expenses of Secretary 84 08 

Clerical help 130 00 

Miscellaneous 33 70 

Chemical and microscopical supplies. . 20 06 

Total $3,000 00 



Reports from Medical Correspondents. 



Nearly all of these reports are for only the first nine months of the 

year 1886. 



Abbot — C. D. Sprague, m. d. 

Diphtheria — Two fatal cases. 
Typhoitl Fever — None reported. 

There was one death from phthisis, and two from diarrheal dis- 
eases of children. Whooping cough went through the schools. 

Alfred— F. W. Smith, m. d. 

Diphtheria — Two cases, not fatal. 

T3'phoid Fever — One case, recovered. 

Scarlet Fever — Three cases, none fatal. 

From phthisis there has been one death. The diarrhn?al disease* 
have been quite prevalent, the most frequent cause of which has been 
impure water. In our village there is a low piece of land that ought 
to be filled, as its odor is very bad during hot weather. It is floodeci 
nearly all the time. 

A large number of horses in this town have been sick this summer^ 
and the dogs in Sanford. The trouble has been in their throats, which 
swell and sometimes burst, it is said. 

Alton — A. H. TWITCHELL, m. d. 

Diphtheria — Three cases, none fatal. 

Typhoid Fever. None observed. 

Upon the whole it has been an unusually healthy season. There 
was a prevalence of who(>ping cough having as a noticeable feature 
•the absence of the distinctive whoop in a large percentage of the 
I'uses. 

(67) 



QS STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

As sanitary improvements I would suggest the building of three or 
four good sensible school-houses in place of the rickety tumble-downs 
where the schools are now held 

A case has come under ray observation in which the contagion of 
diphtheria seemed to have retained its vitality for eighteen months in 
rooms and perhaps in the clothing. 

Andover — Walter W. Barnes, m. d. 

Diphtheria — None observed. 
Typhoid Fever — No cases. 

The summer complaint of children has prevailed to an unusual 
extent. 

Anson — E. M. Wing, m. d. 

Diphtheria — None. 

T3'phoid Fever — Two cases ; one in Embden, fatal. 

The diarrhosal diseases of children have been very prevalent, the 
most frequent causes of which have been neglect, filth and poor 
diet. In September there was an epidemic of dysentery. 

Applelon — Frank A. Gushee, m. d. 

Diphtheria — None. 

Typhoid Fever — No cases. 

We have had one case of severe enteritis and quite a large num- 
ber of light cases continuing half a week. In the severe case a high 
atmospheric temperature followed by a cool exposure at night was 
evidently the cause. 

Anhurn — A. M. Peables, m, d. 

Diphtheria — Twenty-two cases in Auburn, and five in Lewiston. 

Typhoid Fever — Five cases in Auljurn, four in Lewiston. 

Scarlet Fever — Twelve cases in Auburn, six in Lewiston. 

From phthisis there were in my practice three deaths in Auburn, 
and four in Lewiston. F'rom Lake Auburn we have a very excellent 
water supply in this town. We have given attention to sewerage. 
There is less diphtheria and typhoid fever in our city, where it is 
thickly settl(;(l and where we have Lake Auburn water and sewers, 
than on the farms outside the city proper. 



REPORTS OF MEDICAL CORRESPONDENTS. 69 



Augusta — L. J. Crookek, m. d. 

Diphtheria — None observed. 

T3phoid Fever — None oliserved in the city. 

Our local board of health is doing an excellent work. I have 
known scarlet fever to be carried in clothing from one town to 
another and that in very cold weather, and have known diphtheria 
to be communicated to a family by moving into a house where the 
disease had caused deaths three months previously. 

Augusta — J. O. Webster, m. d. 

Diphtheria — Two cases observed, one fatal. 

Typhoid Fever — Two cases, both recovering. 

Scarlet Fever — Six cases observed. 

From phthisis there have been three deaths under my observation. 
There has been quite a large number of cases of the diarrho?al dis- 
eases in children. The more frequent cause of these diseases has 
been the hot and dry weather with artificial feeding. Pneumonia 
was quite prevalent in June and was unusually fatal. 

Augusta — G. H. Brickett, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Ten cases, with two deaths. 

From phthisis there have been three deaths. Infantile diarrhoea 
has been quite prevalent, seeming to be caused mostly by exposure 
to cold, and improper food. 

A better system of sewerage would be an improvement. There 
has been considerable work done in this direction the past year and 
there will be more done next. 

Bar Harbor — C. C. Morrison, m. d. 

Diphtheria — Eleven cases, four fatal. 

Typhoid Fever — Six cases, one died. 

The cases of diarrh(x^al diseases in children have come under 
observation quite frequently ; four have died. Bottle-fed babies 
have suffered severely and I believe the artificial feeding to have 
been the cause of every death. None of the children have died 
that were nursed. 



70 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

About the middle of June, 1886, I was called to see an Indian, 
aged nineteen, who had been out shooting sea birds on some of the 
larger islands near Mount Desert. I found he had typhoid symptoms 
and on enquiry, he gave history of drinking water from the outlet of 
a meadowy alder swamp. It ran very slowly and he said it was 
quite full of green slime which was clinging to every twig in the 
stream. The next morning after seeing the Indian, I was called to 
see a young fellow of seventeen who had been gunning at the same 
islands but not a companion of the Indian. He also had typhoid 
symptoms, and on asking if he had drank from any old well, he said 
he drank from the above place. He did not know the Indian had 
given me any history of such a place, neither was he any acquainted, 
nor had he been with him. The drinking was about ten days or 
two weeks before I saw them. They both had about four weeks 
run of typhoid fever and recovered. There had been no typhoid 
fever for weeks previous, nor did there follow an}' for weeks after. 

Baring — J. R. N. Smith, m. d. 

Diphtheria — Two cases in Baring, both recovering, and two in 
Meddybemps, one fatal. 

Typhoid Fever — None observed. 

Scarlet Fever — No cases in Baring ; three in Meddybemps, and 
one in Charlotte. One case fatal. 

One death from consumption has occurred in ni}' practice in Baring 
and one in Cooper. The diarrheal diseases have been quite pre- 
valent, and three children have died. 

Bath — A. J. Fuller, m. d. 

Diphtheria — Two cases observed. 

Typhoid Fever — I have not seen a genuine case of typhoid during 
the year. 

Scarlet Fever — Two cases observed. 

From phthisis there have died in my practice two cases in Bath and 
one in Freeport. The diarrlucal diseases have not been very pre- 
valent. In this town the year has been very liealthy, with the excep- 
tion of quite a prevalence of measles last winter. 

Good sewerage would improve the condition of liath, as it will that 
of any [)lacc. A few cases of lead poisoning in painters have come 
under ra^' observation. 



REPORTS OF MEDICAL COPRESPONDENTS. 71 

Bath — E. M. Fuller, m. d. 

The total number of deaths in Bath for the nine months of 1886 
ending October 1st, was 149. Arranged by months the mortality 
was as follows : 

Januar}' — Old age 2, dyspepsia 1, pneumonia 1, consumption 2, 
dropsy 1, cancer 3, marasmus 1, Bright's disease 1 ; total, 12. 

February — Consumption 4, typhoid fever 1, abscess of lung 1, 
paralysis of heart 2, pneumonia 1, measles 1, still born 1, old age 1, 
apoplexy 1 ; total, 13. 

March — Pneumonia 2, rheumatism of heart 1, old age 1, still born 

1, disease of heart 2, cerebro-spinal-meningitis 1, dropsy 2, drowned 

2, consumption 1, heart and lung disease 1, measles 1, paral^'sis 1, 
unknown 1 ; total, 18. 

April — Inflammation of bowels 1, bronchitis 1, still born 3, paralysis 
1, pneumonia 1, canker 1, cystitis 1, consumption 2, heart disease 
1, tubercular meningitis 1, Bright's disease 1, unknown 1 ; total, 1.3. 

May — Inflammation of bowels 1, marasmus 1, canker of stomach 
1, pneumonia 1, paralysis 2, heart disease 1, Bright's disease 1, con- 
sumption 2, cholera infantum 1, unknown 1, cancer 2, accident 1, 
canker 1 ; total, 16. 

June — Canker 1. cholera infantum 1, congestion of brain 1. con- 
sumption 3, rubeola 1, apoplexy 1, dropsy- 1, heart disease 2, still 
born 3, typhoid pneumonia 1, meningitis 1, paralysis 2, croup 1, 
rheumatism of brain 1 ; total, 20. 

July — Consumption 2, paralysis 2, marasmus 1, insanity 1, pneu- 
monia 1, cancer 1, suicide 1, drowning 1, still born 1, whooping cough 
1 ; total, 12. 

August — Cholera infantum l."), still born 2, consumption 4, disease 
of brain 1. marasmus 1, dropsy 1, indigestion 1, dysentery 1, child 
bed fever 1 ; total, 25. 

September — Paralysis 2, unknown 1, cholera infantum 3, maras- 
mus 2, nervous prostration 1, pneumonia 1, dropsy 3, drowned 2, 
heart disease 1, diphtheria 1, old age 1 ; total, 18. 

Bath — M. S. Bkiuv, m. d. • 

Diphtheria — None observed. 
Typhoid Fever — Two cases. 

There have been three deaths from phthisis. The diarrha>al dis- 
eases in childien have been more prevalent than usual, and three 



72 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

deaths have occurred. Improper feeding is the more potent cause ; 
the three cases who died were under five mouths of age and all were 
fed from the bottle. None have been lost who nursed the breast. 

Measles and mumps prevailed during the winter aud spring ; they 
were brought here from an adjoining town. The condition of the 
town would be improved if the privies and cess-pools were properly 
constructed and cleaned at suitable times. 

One of the cases of typhoid fever which I have mentioned occurred 
iu a 3'oung girl of sixteen, the daughter of a sea captain. While her 
father's vessel was in reloading she occupied the cabin which had been 
occupied by another captain on a recent return voyage from Balti- 
more, On this return voyage this captain was sick with what was 
called malarial fever, but not intermittent fever. I think that the 
same blankets were also used by my patient that had been used by 
the sick man. The water used on board was taken in part from the 
Kennebec River and in part at Baltimore. 

Belfast — Jas. H. Sherman, m. d. 

Diphtheria — Two mild cases contracted elsewhere. 

Typhoid Fever — None observed. 

Under my observation three deaths from phthisis. The diarrhoeal 
diseases of children have been less prevalent than usual. Impru- 
dence in eating has been the cause in every case under my observa- 
tion. It has been an unusually healthy j'ear here. 

Our drainage is largely upon the surface, and hence the chances for 
the contamination of the wells by the introduction of surface water 
are great, but from the continuous drought there has thus far been 
but little wash from the hills. Should there be heavy rains this 
autumn, I look for a large increase of sickness, with probably more 
fatality. 

Biddeford — S. J, Bassford, m. d. 

Diphtheria — Two cases, both recovering. 

Typhoid Fever — Five cases, one fatal. 
* Under my observation tlicre have l)een two deaths from phthisis 
in Biddeford, aud one in Saco. During the summer months the 
diarrhoeal diseases of children wore very prevalent, and dysentery 
has prevailed much more than usual. Those diseases I think are 
due to the iuliucuce of the weather, unhealthy surroundings and 



REPORTS OF MEDICAL CORRESPONDENTS. 73 

improper food. Whooping cough has been quite prevalent and a 
number of deatlis have resulted from it among the French children, 
but none, I think, among Americans. 

For the improvement of our cit}' I would suggest better drainage, 
closing certain wells and the introduction of water into tenements. 
"We have a good water supply lately introduced and already much 
has been done towards improvement. 

Two cases of typhoid fever, I feel sure, were caused by drinking 
water taken from polluted wells. The water was analyzed, con- 
demned, and the wells were closed. Much credit is due our present 
board of health for efforts put forth, to put down certain nuisances, 
such as i)olluted wells, foul privies, etc. Some of the phj-sicians 
have assisted and entered complaints of unhealthy localities, and the 
board has done its duty. AVe are encouraged to complain more, and 
thus see more accomplished. 

Biddeford — Frederick Bacon, m d. 

Diphtheria — Six cases observed and one death. 

Typhoid Fever — None observed. 

From phthisis there has been one death in my practice. The 
diarihd'al diseases have been somewhat [)revalent among the French 
children. I have thought that one cause of these diseases has been 
due to bad drainage. 

Biddeford — C. J. Emery, m. d. 

Diphtheria — Four cases, two fatal. 

Typhoid Fever — Twenty-two cases in Biddeford, one fatal ; one 
in Saco. 

Scarlet Fever — One case, recovered. 

Under m}' observation there have been three deaths from phthisis 
in Biddeford. The diarrha^al diseases of children have l)een very 
prevalent, and particularly dysentery. Two deaths have resulted. 
As causes of these diseases have been improper food, too early 
weaning on account of the parent's desiring to work in the mills, 
exposure and iilih. "Whooping cough and measles have been prev- 
alent, the former very fatal to children under two years of age. 

Better sewerage and more attention to proper tra[)ping would 
improve our health conditions. Vaults are necessarily emptied into 
sewers and the community generally do not understand the necessity 
of trapping. 



74 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

One case of lead poisoning came under my observation in the 
case of a plumber. The lead appeared to have been taken in by 
chewing tobacco which had received the lead from the hands of the 
man. 

Biddeford — S. Abbott, m. d. 

Diphtheria — Four cases observed in Biddeford, and one in Saco ; 
none fatal. 

Typhoid Fever — None observed. 

Bootlibay — Alden Blossom, m. d. 

The mortality of Boothbay for 1886 has been as follows: 

January, 9 

February, 2 

March, 3 

April, 1 

May, 5 

June, 7 

July, 8 

August, 3 

September, 7 

October, 8 

November, 2 

December, 5 

AGES. 

Under 5 3'ears 14 

Between 5 and 10, 5 

'' 10 and 20, 9 

" 20 and 30, 3 

" 30 and 40, 3 

" 40 and 50, 3 

" 50 and GO, 5 

" 60 and 70, 7 

" 70 and 80, 8 

" 80 and 90, 3 

Consumption 9, pneumonia 4, rheumatism 2, heart disease 4, 
scrofula 1, gun sliot wound 1, old age 3, diabetes 1, drowned 2, mar- 
asmus 4, neuralgia of brain 1, l)roncliial catarrh 1, cancer 1, jaundice 
1, intussusception 1, Bright's disease 1, gastritis 1, diarrhceal diseases 



REPORTS OF MEDICAL CORRESPONDENTS. 75 

5, cerebro s[)inal meningitis 1, still born 1, typhoid fever G, gastric 
catarrh 1, diphtheria and croup 6, dropsy 1, fits 1 ; total, 60. 

Brewer — C. P. Thomas, m. d. 

Diphtheria — Four cases, three in Eddington. 

Typhoid Fever — Two cases. 

Scarlet Fever — None in this town ; three cases in Eddington, one 
fatal. 

From phthisis I have observed two deaths, one in Eddington. The 
diarrha^al diseases of children have been quite prevalent, with one 
fatal case. The most frequent causes have been extreme heat and 
poor water. There has been no epidemic except of whooping cough. 

For improving the general sanitary- condition of this place better 
sewerage and cleaner wells might be mentioned. 

One case of long retention of the vitality of the diphtheria conta- 
gion came under my observation. A man brought home some clothes 
and rags from a town where they had had this disease the year be- 
fore. These rags were put in the barn and the children played on 
them and in a few days came down with diphtheria and nine persons 
in the family were sick. The vitality of the contagion in this case 
was retained nearly one year, if the children received the infection 
from the rags, as was probable. 

Brewer — L. H. Wheeler, m. d. 

Diphtheria — Three cases. 

Typhoid Fever — One case. 

The diarrhojal diseases of children have been very prevalent. The 
hot weather, improper diet, and dentition have been the more potent 
factors in producing the disease. 

To improve the sanitary condition of the village I would suggest a 
better water supply. 

One case of diphtheria seemed to be due to emanations from a 
foul sink drain and other filthy accumulations about the building. A 
case ot diphtheria came under my observation which seemed to be 
contracted by using a pillow which had been on the bed of a former 
diphtheritic patient six months previously. The pillow in the mean- 
time had been cleansed by the steam process, or was said to have 
been so cleansed. 



76 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 



Bridgton — John B. Bray, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case, still sick. 

One case of poisoning from lead occurred as follows : A bo}' four- 
teen years of age had been poisoned with "■mercury," or poison ivy, 
and his parents washed the pustular eruption with a solution of ace- 
tate of lead of unknown strength. The result was a ver}' serious 
case of lead poisoning from which the patient is still suffering though 
now somewhat better. 

Bridgeivater — W. W. White, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Two cases in Mars Hill, one in Blaine. 

From phthisis one patient died in Bridgewater, and one in Blaine. 
The diarrho^al diseases of children have been quite prevalent, caused 
by improper diet and impure air. During the year there has been a 
marked prevalence of pneumonia and dysentery. 

Last year a healthy young girl assisted in removing the wall paper 
from a room in which there had been treated a case of typhoid fever 
the year before. In less than two weeks after removing the paper 
she was taken to bed with typhoid fever. There were no other cases 
in the settlement previous to her taking it. 

Brooks — J. T. Collikr, m. d. 

Dii)hthcria — No cases observed. 
Typhoid Fever — One case under my observation. 
The not verj' prevalent dian-hoeal diseases in children have been 
caused here b}- green apples and cucumbers. 

Brownjield — W. L. Gatchell, m. d. 

Diphtheria — None observed. 

Tyi)hoid Fever — Two cases, one fatal. 

One death from phthisis. The summer diseases of children have 
been unusually infrequent. If there has been an}' peculiarit}' in the 
diseases this year it is that the "summer complaints" have been more 
common among adults than among children. Measles and whooping 
cough prevailed in the schools. 



REPORTS OF MEDICAL CORRESPONDENTS. 77 

Brownville — W. Sawyer, m. d. 

Diphtheria — In Brownville, twenty cases, one fatal. In Katabdin 
Iron Works fifteen cases, none fatal. 

Typhoid Fever — None observed. 

One death from phthisis. The diarrhoeal diseases of children have 
been quite prevalent. In my opinion the bad condition of a slaughter 
house in the village has contributed largely as the cause of the prev- 
alence of diphtheria. At Katalidin Iron Works I think that better 
drainage should be enforced. The drinking water there is probably 
badly contaminated. 

Biiinstvick — 0. F. Pare, m. d. 

Diphtheria — One hundred and fifty-two cases in my practice, with 
nineteen deaths. 

Typhoid Fever — Seventy-eight cases, eleven deaths. 

From phthisis three deaths in my practice. The diarrhoial diseases 
of children have been very prevalent and sixteen deaths have resulted 
from them. The cause of these diseases I think ma}' be referred 
largely to the milk supply. Tlie cows in this district are kept in close 
contact with privies which are overflowing and the}' are fed on putrid 
swill. Two facts will sustain this opinion : 1st, Previous to this 
year there were only a few cows kept amongst the French people, 
this year there are twenty-seven cows, which furnish nearly all the 
milk used. 2nd, The milk bought from milk carts, or the milk from 
the country, can be kept sweet six or ten hours longer than that 
which is produced by the cows which are fed on the putrid swill. 
Among adults the diarrhcual diseases have been largely due, I think, to 
polluted water and to air wliich is rendered impure by the crowded 
condition of the population and the neglect of the sanitary conditions, 
such as were seen by you. 

I should like to emphasize particularly the ill results of keeping 
cows in this crowded Fiench population, and would wish to draw 
attention to the fact that the larger number of the fatal cases of the 
diarrha-al diseases have occurred in tlie children who have used the 
milk from these swill-fed cows ; and on many occasions when the 
milk supply has been changed and the milk from the country taken 
instead of the other, the ciiildren would speedily improve and get 
well without an}' medicine. There have been but very few exceptions 



78 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

to this. The milk of these swill-fed cows eau be kept sweet only a 
few hours after the milking. 

Regarding the deaths from consumption, I would say that I know 
of six cases besides the three reported above who went back to 
Canada to die, as is a common occurrence with these French Canadians 
•when they are attacked with any similarly serious disease. 

Bucksport — Geo. H. Emerson, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case. 

Two deaths from phthisis. The diarrhoeal diseases have not been 
very frequent. The sanitary condition of this localit}' would seem 
to be good, as indicated by the small number sick during the last 
year. 

Buxton — J. A. Fellows, m. d. 

Diphtheria — In HoUis, two cases. 
Typhoid Fever — In Buxton, one case ; in Hollis, two. 
In Hollis one death from phthisis, the same in Buxton. Rheuma- 
tism and neuralgia have been quite prevalent. 

Buxton — F. A. Southavick, m. d. 

Diphtheria — Six cases, two fatal. 

Typhoid Fever — Saco, two cases ; Scarboro, three, none fatal. 

One death from phthisis. Of the diarrho'al diseases of children 
there have been upwards of fifty cases, one death. A large part of 
my cases occurred in the summer months when we were having hot 
days and cold nights, hence I believe climatic influences a potent 
cause Eating blueberries, green corn, and cucumbers cause many 
cases. 

The general sanitary condition of the town is good, but there are 
but few who might not improve the sanitary condition of their dwell- 
ings. Diijhtheria broke out in our school, four being taken in dif- 
ferent families at about the same time. The school was closed and 
there was no further extension of the disease. 

Buxton (Bar Mills) — Mautin Coffin, m. d. 

Diphtheria — None observed. 
Typhoid Fever — Two cases. 

From phthisis one death in Hollis. The diarrhcjcal diseases have 
been very prevalent among adults as well as children. 



REPORTS OF MEDICAL CORRESPONDENTS. 79 

Cambridge — G. F. Merrill, m. d. 

Diphtheria — Two cases in Cambridge, and three in Harmony. One 
fatal in each place. 

Typhoid Fever — One case. 

Scarlet Fever — One case. 

One death from phthisis in Parkman. The diarrhnpal diseases of 
children have been very prevalent ; the most common cause has been 
artiticial feeding. 

Caribou — J. Cart, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One in Caribon, and three in Washburn, one of 
which in the case of an infant ended fatall}' in convulsions. 

One death from phthisis in Washburn. During the last of Au- 
gust and through most of the month of September the diarrhoea! 
diseases of children were ver}' prevalent ; from them one death oc- 
curred in Caribou, and two in AYashburn. According to my observa- 
tion drouth is the most potent cause of these diseases ; cases improve 
and the malady disappears after the advent of copious rain. I would 
suggest for diminishing the prevalence of these diseases the use onl}' 
of pure water and the boiling of any water which is suspected of be- 
ing otherwise. 

For the improvement of our general sanitar}' condition I would 
suggest a system of public water works and a sewerage system. 

Castine — J. H. Sylvester, m. d. 

Diphtheria — Three cases in Castine, and one in Brooksville. 

Typhoid Fever — Three cases observed. 

Scarlet Fever — Six cases in Castine, four in Brooksville. 

P^'om phthisis two dwths in Castine. The extreme drouth and 
bad water supply caused an unusual prevalence of the diarrha^al dis- 
eases of children. Our sanitary condition would be improved by 
digging the wells deeper and improving the house and street drainage. 

At Brooksville a father came home from sea with scarlet fever and 
communicated the disease to his family. He derived the disease 
from the clothing of one of his men whose family had suffered from 
the disease some six months previous to his going to sea. 



80 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 



Castine — G. A. "Wheeler, m. d. 

Diphtheria — Three eases in Castine, twelve in Penobscot, of a 
mild form, none fatal, but unmistakabl}' diphtheria, 

Tj'phoid Fever — One case, fatal, did not originate here. * 

Scarlet Fever — Two cases in Castine, three in Penobscot. 

No deaths observed from phthisis. The diarrha^al diseases in 
children have been very prevalent, though no deaths were observed. 
As causes, the hot weather and indiscretion in diet have been the 
more operative. 

Pneumonia, bronchitis, acute rheumatism, and cholera morbus 
have been more prevalent than usual. An annual house to house 
inspection of the town would improve its general sanitar}'' condition. 

A woman from another town visited her friends in Penobscot. 
She stayed one night at a house where they had had diphtheria six 
months before. B}' accident she was compelled to put on a night 
shirt of a 3'oung lad who had been ill with the disease. Within a 
week or ten days she was taken down with diphtheria. Tiie whole 
house had been disinfected and, it was supposed, all the clothing. 

Glierryfield — C. J. Milliken, m. d. 

Diphtheria — No cases observed. 

Typhoid Fever — One case. 

Scarlet Fever — Three cases. Five deaths from phthisis in Cherry- 
field, one in Columbia. The diarrheal diseases of children have been 
very prevalent in a mild form, though one case has resulted fatally'. 
The hot, dry weather has seemed to be the cause. Upon the whole, 
there has been but little sickness in the town during the year. 

China — F. C. Perkins, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Two cases in "Windsor. 

Scarlet Fever — Five cases in Vassalboro, one fatal. From phthi- 
sis one death in China, two in Windsor. The diarrhfual diseases 
of children have not been very prevalent. 

Scarlet fever has spread through one school in Vassalboro, nearly 
all the scholars having the disease at about the same time. 



REPORTS OF MEDICAL CORRESPONDENTS. 81 

Corinna — 0. H. Merrill, m. d. 

Diphtheria — None observed. 

T^-phoid Fever — Eight cases. 

Six deaths from phthisis. The so-called summer complaint has 
been very prevalent among children ; two deaths have occurred. 
Improper food is the most common cause. 

Corinth — E. H. Stanhope, m. d. 

Diphtheria — Six cases in Lagrange, four in Charleston. 

Typhoid Fever — Four cases in Lagrange, one in Corinth. 

From phthisis there has been one death each in Lagrange, Cor- 
inth, and Orneville. The bowel diseases of children have been very 
prevalent ; one death occurred in Lagrange. The more frequent 
cause has lieen eating indigestible substances, and the hot weather. 
I think this is a very healthy locality, plenty of pure air and pure 
water. 

One case of the contagion of diphtheria communicated at a funeral 
was in the case of a man who died in the woods and was brought 
out. Ilis brother took the disease and had a severe sickness, but re- 
covered. Another case of diphtheria was communicated by infected 
clothing. 

I call to mind one case of sporadic fever in the town of Lagrange. 
The patient was a little girl ten years of age. Her home was beau- 
tifully* situated on hi;rli ground. Everything about the house, both 
inside and out, was perfectly neat. The water used was from the 
well where others obtained their supply. She was attending school 
at the time her sickness began. The fever ran forty-two davs and 
she was delirious twenty days. There were no other cases in town 
at that time. Certainly her disease could not come from filth or 
cesspool, for there was no such thing in the whole village. It seems 
to me as though such cases as this do not agree with the prevailing 
theory regarding typhoid fever. 

Corinth — C. S. Piiilbrick, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

One death from phthisis in Corinth, and one in Bradford. The 
diarrha\al diseases of children have been moderately prevalent, 
caused, it would seem, this fall by atmospheric influence. G 



82 STATE BOAKD OF HEALTH — SECRETARY'S REPORT. 



Cornish — O. M. Brown, m. d. 

Diphtheria — Four cases. 

Tvphoicl Fever — None observed. 

Scarlet Fever — One case in Sebago. The bowel diseases of chil- 
dren have been very prevalent, and one death occurred. The fre- 
quent cause of this disease has been the eating of unripe fruit. 

There has lately been a disease which closely resembles influenza, 
the germ or cause of which seems to have been transmitted b}' the 
medium of the atmosphere. 

Many things might be suggested to improve the sanitar}- condition ; 
improving the drainage of many of the houses is one of them. 

Cumberland Mills — A. F. Murch, m. d. 

Diphtheria — None observed. 

T3'phoid Fever — None observed. 

Scarlet Fever — One case. Two deaths from phthisis. The 
diarrhrpal diseases of children have been quite prevalent. A frequent 
cause of the disease has been improper feeding. 

One case of scarlet fever came under m}- observation which seemed 
to have been contracted by wearing clothing which one year before 
had been worn by a scarlet fever patient. 

Cumberland — C. T. Moulton, m. d. 

Diphtheria — Seven cases in Cumberland, three in Falmouth. 

Typhoid Fever — One in Cumberland, one in Falmouth. 

One death from phthisis. Tlie dianha^al diseases of children have 
been very prevalent ; one death. Errors in diet, together with 
atmospheric influences, have had much to do in causing this disease. 
The sanitary condition of Cumberland Center is very good — much 
better than that of most country villages. 

In October, 1885, 1 was called to see a little girl nine years of age, 
who had l)cen sick some four da3's with what the famil}' called a bad 
cold and sore throat. I found the little patient almost in a moribund 
condition — a case of malignant diphtheria, and she died the next day 
hut one. The sanitary condition of the place seemed very good ; 
no other cases of diphtheria were in the neighborhood. I ascer- 
tained that the grandfather, an aged gentleman, of whom the child 
was ver}' fond and in whose lap slie would sit much of the time, had 
come from a neighboring town to spend a few weeks with them — that 



REPORTS OF MEDICAL CORRESPONDENTS. 83 

in his family in the })revious June there had been several cases of 
diphtheria, one fatal case. The children had been sick in a room 
adjacent to which was a clothes-press where the old gentleman's clothes 
had hung. He had had no occasion to use them until tlie present 
visit to his daughter's. Tliat clothes-press was not disinfected, hence 
the communication to my patient, I think. The father of the little 
girl was taken sick with diphtlieria in just one week from the da}' the 
child was confined to her room ; he recovered. One bo}- thirteen years 
of age in the family was kept out of the room, and all precaution 
taken to prevent the further spread of the disease. Directions were 
given for thorough disinfection. No other case occurred in that house 
or in that neighborhood at that time. In January, 1886, I was again 
summoned to the same house to see the boy before mentioned, who 
was sick with what I pronounced diphtheria, although no membranes 
had yet made their appearance. The case seemed a mild one. The 
next day I found light membranous formations with the usual S3'mp- 
toms. On the fourth day a " professional nurse" was called to care 
for the boy. She immediately applied a tobacco poultice to the throat, 
and thoroughly steamed him with vinegar, as she said, and she thought 
the boy better. The next day I found the nasal cavity, also the larynx 
involved, — result, patient died the next day from suffocation. I will 
give no further particulars of these cases, as enough has been said to 
show that the contagion will remain for a long time in contact with 
clothing and articles of furniture without losing its virulence. 



Cumberland Mills — John Swan, m. d. 

Diphtheria — None observed. 
Typhoid Fever — One case. 

Two deaths from phthisis, and two from the bowel diseases of 
children. 

Damariscotta — E. F. Stetson, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

One death from phthisis. The diarrheal diseases of children have 
not been very prevalent. Most of the cases have been caused by 
indiscretion in diet. 



84 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

Danforth — M. L. Poter, m. d. 

Diphtheria — No cases observed. 

T^'plioid Fever — Two cases. 

Two deaths from phthisis. Tliere has been an unusual prevalence 
of "summer complaint" and two children have died. Weather 
changes have had much to do with the disease. I would suggest 
better drainage to improve our sanitary condition. 

Dehlois — I. C. Davis, m. d. 

Diphtheria — None observed. 

Typhoid Fiver — None observed. 

The diarrho'al diseases have been ver}' prevalent among the ciiil- 
dren, but have been very mild. 

Last year some kind of a disease not classed, affected quite a large 
number of cows, and about one-tliird of those attacked died. Tlie 
disease extended over a number of towns. 

Dexter — W. A. Bumps, m. d. 

Diphtheria — Three cases. 

Typhoid Fever — Two cases in this town, two in Garland. 

Scarlet Fever — Tliree cases. From plithisis two deaths. There 
have not many children been sick with the diarrhoeal diseases. No 
diseases have been ver}' prevalent excepting tonsillitis. I would 
suggest a better condition of sewerage. A disease has been quite 
prevalent amongst swine in some localities. 

A young man visited Dexter three w^eeks after his recovery from 
diphtheria in Skowhegan. Apparently by means of his clothing he 
communicated the disease to two persons. I have known scarlet 
fever to have l^een contracted by occupying a room and using cloth- 
ing one year after they were infected. 

The whole nun)ber of deaths in town has been 36. P'rom cerebro- 
spinal-meningitis, 2 ; pneumonia, 2 ; paralvsis, 8 ; heart disease, 
4; phthisis, 11 ; cancer, 3; infantile disease, 2; cirrhosis, 1 ; sep- 
ticaemia, 2; Brighfs disease, 1. 

Dixfield — Ja9. S. Stuutkvant, m. d. 

Diphtheria — None observed. 
Typhoid Fever — Three cases in l*eru. 

The bowel complaints of children have been very prevalent, caused 
principally by improper food and bad water. 



REPOllTS OF MEDICAL CORRESPONDENTS. 85 

Eaton — P. "W. Cody, m. d. 

Diphtheria — Twelve cases, six fatal. 

Typlioid Fever — Five cases, two fatal. 

Scarlet Fever — Six cases, two fatal. Six deaths from phtliisis. 
The diarrhfjeal diseases of children have been very prevalent, with a 
considerable mortality. The mode of feeding has much to do with 
its cause as I have observed that in nearly all the cases I have at- 
tended, cow's milk has been substituted instead of the breast milk. 
Another cause observed b3' me has been, feeding children with indi- 
gestible and improper food. 

Our town, in respect to its sanitation, is in a very unsatisfactory 
condition. We have no health authorities to look after our surround- 
ings. Wells in many cases are in close proximity to privies, and these 
are generally left in a filth}' condition, with the accumulations some- 
times unremoved for years. In fact we need a very great change 
and it has surprised me much that more diseases do not occur in our 
midst. 

I attended a case of typhoid fever some months ago. The patient 
was a young man aged twenty-one years. The cau>ie of the disease 
seemed to be drinking water from a spring and well lioth situated so 
that they received all the drainage from the barn-yard which was 
used as a privy, as none other was erected on tlic premises. I 
ordered a discontinuance of the use of said water, and tiiey obeyed. 
Four weeks after the first patient was taken sick, his brother, aged 
twentv-eight years, showed symptoms of the disease and in a few 
days the case was fully developed. As the brother did not reside in 
the house with iiis sick brother, but in one near to it, I was at a loss 
to know the cause of his contracting the disease, as his surroundings 
were in an excellent condition. But on questioning his wife I learned 
that their well became dry and that they had been using the water 
from the well that was contaminated, thinking that it was nonsense 
to follow the directions 1 had given the others. Both brothers re- 
covered and the first has constructed a water closet and obtains water 
from a new well situated in a proper place. 

Eliot — J. L. M. Willis, m. d. 

Diphtheria — Ten eases in Eliot, two in Kittery, one in South 
Berwick. 

Typhoid Fever— Seven cases, one fatal ; two in South Berwick, 
one in Kittery. 



86 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

Scarlet Fever — Seven cases in the town, one fatal. Bad water 
and improper food appear to liave been the principal causes of the 
diarrhu'al diseases of children, which have been unusually prevalent. 
There has also been a greater prevalence than usual of dysentery', 
probably caused by the small rainfall and the lowness of the water 
in the wells. 

Exeter Mills — S. W. L Chase, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Four cases, one fatal. 

One death from phthisis. The diarrhoeal diseases have been quite 
prevalent among children, due largel}' to faulty sanitary conditions. 
Whooping cough appeared to have been brought into the town through 
infected clothing. 



Fairfield — M. S. Goodrich, m. d. 

Diphtheria — Eleven cases, one fatal. 

Typhoid Fever — Eight cases, one fatal. 

There has not been as great a prevalence as usual of the diarrhoeal 
diseases of children ; two deaths. The cause is largely the heat 
and improper diet. 

In Fairfield we have no local board of health, and to improve the 
general sanitar}' condition of the place I would suggest that we have 
such a board if there is any way of having it. 

Fairfield — F. J. Robinson, m. d. 

I was called to see a little girl about six years of age, whom I 
found alfected with a well marked case of diphtheria. Before this 
one there had been no cases of this disease of any importance in the 
village for a long time. I was told by the mother that her boy had 
a few days previously had a sore throat and that he had patches in 
his thiout, but was not very sick and so no physician was called to 
him. • Slie also told me that when this boy was an infant he was very 
sick with di[)htheria and that in years i)ast, several times each year, 
he had sullered with sore throat with patches in it as mentioned. I 
remember of meeting other similar cases. 



REPORTS OF MEDICAL CORRESPONDENTS. 87 

Fairfield — D. C. Pekkins, m. d. 

Diphtheria — Three cases. 

Typhoid fever — Four eases. 

Tlie bowel diseases of children have been quite prevalent. Sev- 
eral eases were directly traceable to improper diet 

There has been a greater prevalence of typhoid fever than usual, 
but its cause has been very obscure. I have no doubt tliat cleanli- 
ness and isolation of indivitluul cases would diminish the prevalence 
of the disease. 

Better drainage and a health committee that would do its duty 
could improve the general sanitary condition of the village. One 
serious case of illness came under my care, resulting from eating 
canned beef. Another from bad pork ; others from food improperly 
cooked. 

Farmingdale — F. M. Putnam, m. d. 

Diphtheria — Two cases. 

Typhoid Fever — One case. 

Scarlet fever — One case. Among children the diarrlural diseases 
have been quite prevalent, due in greater part, probably, to the hot 
weather, improper food and impure air. 

Fort Fairfield — A. J). Sawyer, m. d. 

Diphtheria — None observed. 
Typhoid Fever — Plight cases, one fatal. 

Three deaths from phthisis. Infantile diarrluea has not been es- 
pecially prevalent. 

Freeport — D. D. Spear, m. d. 

Diphtheria — None observed. 

Typiioid Fever — One case. 

Two deaths from phthisis. The diarrha'al diseases of children 
have not been very prevalent, one death only resulting. At the 
time of this report there is an unusual prevalence of pneumonia ; I 
have now on my hands three cases in one family, two in another, 
and one in another. Causes, proliably, the recent damp weather. 

The past year there has been but little sickness in Freeport. I 
find recorded seven fatal cases — one old age, 82 ; one cystitis, aged 
77 ; two of consumption, aged ^7 and 81, respectively ; one cancer 



88 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

of the stomach, aged 47 ; one case of cholera infantum, 3 months ; 
one case of puerperal fever, aged 26. These are all the fatal cases 
occurring in my practice since October 1, 1885, which is somewhat 
remarkable and unusual. Typhoids are always rare here. Most of 
the deaths in Freeport result from pneumonia or have pneumonia as 
an original cause. Tlie form of consumption seen here has resulted 
from frequent inflammation of the lungs. Yet we do see here some- 
times true tuberculous consumption, but it is not prevalent. 

Freeport — H. F. Twitchell, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case. 

Scarlet Fever — Six cases. 

Among children the diarrha\al diseases have been quite prevalent, 
two cases resulted fatally. Tlie causes have been either a low con- 
dition of tlie water or local atmospheric conditions. I know of no 
diseases having prevailed amongst animals excepting catarrhal 
ophthalmia among dogs. No diseases have spread through the 
schools excepting scarlatina in our primary school, but it was con- 
fined pretty much to that school by quarantine. 

Typhoid fever is extremely rare in Freeport. We have no fresh 
water river. Yarmoutli, six miles west, and Brunswick nine miles 
east, are somewhat noted for this disease. Tiic case reported above 
is the only case, except one imported from Yarmouth, that has 
occurred in our town for two years and perhaps longer. This young 
man camped on French's Island late in August. The water of the 
spring from which he drank was very foul. The island is uninhab- 
ited, but is within two miles of Great Chebeague and not much far- 
ther from the mouth of the Yarmouth River. He had not l»een out 
of our town for more than a few hours for man}' weeks. His fever 
commenced about five days after he left the island and ran the usual 
course of four weeks. 

Friendship — C. A. Parsons, m. d. 

Diphtheria — No cases of the real disease, l)ut a few somewhat 
resembling dii)litheria. 

Typhoid F(!V(;r — A few cases of simple fever, l)ut no marked 
symptoms of typhoid. 

There have been only a few mild cases of the diarrhouil diseases 
of children. 



REPORTS OF MEDICAL CORRESPONDENTS. 89 

Fi'yehurg — W. C. Towlk, m. d. 

Diphtberia — None observed. 

Typhoid Fever — Two oases. 

Scarlet Fever — Three eases. The so-called summer complaint of 
childriMi has been quite prevalent, caused apparently l)y sudden 
changes in the temperature and the low condition of tlie wells and 
the springs. I think that tlie local health otllcer might improve the 
sanitary condition for public houses and boarding-houses. 

Fryehnrg — Geo. H. .Shedd, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case. 

The bowel complaint of children has been very prevalent, with 
one death in Frycbuig. 

I noticed in connection with my scarlet fever patients a posssible 
means of spreading contagious diseases, viz : "sale work." Dur- 
ing the progress of the disease there were in the room, several coats 
partially completed and a number of bundles not undone. If I liad 
not protested vigorously, they would have been sent away by the 
man who delivered them to be completed by some other family or 
families ])efore fumigation. I may say that there were four children 
sick in this family with scarlet fever and. so far as I could loarn. they 
had not been in communication with any known source of contagion. 
The family was an isolated one and no member of it had been away, 
nor had they been visited by any one from away. I know of no 
other cases an3where in their vicinit}-. 

Gardinei — "\V. P. Giddixgs, ji. d. 

Diphtheria — None observed. 
Typhoid Fever — None observed- 
One death from phthisis in Pittston. The diarrha?al diseases of 

children have been very prevalent ; one death in West Gardiner. 

Indiscreet feeding is probably the most potent cause. 

Garland — E. S. Coan, m. d. 

Diphtheria — None observed. 

Typhoid Fever — There has not been a case in town for two years. 

Scarlet Fever — Twent}' cases, but none fatal. The diarrlio-al dis- 



90 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

eases of children have been veiy prevalent, as well as similar diseases 
with adults. 

Twenty-five j-ears ago diphtheria was brought into our neighbor- 
hood by a person who had attended a funeral at a neighboring town. 
Fifty cases resulted, several of which died. 

In August last there occurred in this village eleven cases of cholera 
infantum and cholera morbus within a radius of twenty' rods. All 
of the families in which these cases occurred obtained their water 
from one well. Upon investigation the water in this well was found 
to be very impure. The well had not been cleansed for several 
years. 

During the prevalence of scarlet fever last winter, it was a notable 
fact that where ventilation was imperfect the disease was the most 
severe. Some of the dwellings in which the disease occurred had 
outside windows with no provision for ventilation other than the 
doors. In one instance every window in the lower part of the house 
had outside windows excepting one, and that in a part of the house 
unoccupied. This famih" was under the charge of another ph^'siciau, 
but the cases were all severe and protracted. I have no doubt that 
the severity was due to imperfect ventilation. All the cases recov- 
ered, however, under the skillful management of the attending 
physician. 

The following is a brief history of the first series of cases of typhoid 
fever in my practice. They occurred in the town of Bradford in 
1870. The season had been hot and dry, but about the first of the 
month beav}' rains set in, and lasted for a week, when it became hot 
again. 

October 19,1 was called to attend the wife of Mr. O. ; on the 20th, 
I was called to a bo}' six years of age, son of Mr. P. ; on the 21st to 
attend a girl ten years of age living witii INIr. G. All were cases of 
typhoid fever with well-marked and characteristic symptoms, and all 
these houses were in the same noigiiborhood, the last two within 
forty yards of each other, on opposite sides of tlie street, and tlic first 
about two hundred yards distant. Mrs. O. recovered after a three 
weeks' run of the fever ; tlie girl at Mr G.'s also recovertid after 
sixteen days ; the boy, son of Mv. .!., died on tlie twenty-second day 
from purpura haimorrhagica. 

The point of interest in these cases is the possible cause of tlie in- 
fection. I searched the premises in each case, but could lind no 
cesspool, filth or defective drainage as an explanation of the sickness. 



REPORTS OF MEDICAL CORRESPONDENTS. 



91 



The street upon which the three houses were situated ran north and 
south, the house of Mr. O. being north from the other two. On 
the east side of the street and about seventy yards from it and a 
hundred yards or more from Mr. O.'s well and about tlie same dis- 
tance from the well used b}' Mr. G. and Mr. J., and on ground fifty feet 
higher there was a cemetery, as shown by the accompanying diagram. 
The distances are approximations, as uo measurements were taken. 



Mr. 0. 



Well 



o 



Cemetery. 



Mr. Q. 



Well O 
Mr. J. I 



S. 

The soil was gnivelly and beneath it at a depth of, I think, about six 
feet there was an unpermeable hardpan (.^uery : Is it not probable 
that infection was carried in the subsoil from the cemetery to tlie wells 
on a lower plane in the vicinity ? I would here mention that diphtheria 
had occunod in the same neighborhood ten years previously, and 
that it also occurred there eight or ten years later in a malignant 
lorm. 



92 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

Diphtheria. This town is not naturally a good field for this disease 
to work in. Twelve miles east from liere, in the town referred to in 
connection with typhoid fever, diplitheria caused nearly one hundred 
deatlis in tlie epidemic that visited this State twenty-live years ago. 
Seven miles west from hero is another town where, ten joars ago, 
this fatal disease carried off about the same number. During the 
latter epidemic one famih' in the west part of this town contracted 
the disease by coming in personal contact with it there. Five members 
of this family had diphtheria, and all recovered. No other case came 
from that source. Four 3'ears ago the body of a person who had died 
from the disease and that had been placed in a tomb, was removed and 
interred. Some children were playing in the vicinity, and, attracted 
hy curiosity, went near to the place while the work was going on. 
The}- contracted the disease and it spread to other families. A year 
later one of these families moved to this town. All but one had had 
diphtheria the winter before. AVhen cold weather came on, and 
clothing that had been worn the winter before was brought into use, the 
remaining member of the family, a child six years of age, came down 
with the disease in a putrid form, and after ten days of suffering, died. 
I attended the case, and used every precaution to prevent a spread 
of the disease. No public funeral was allowed. I was more care- 
ful with others than with myself, and in two days after the death 
of the child I came down with diphtheria I immediately iso- 
lated myself and prepared for battle. I had the disease in a 
severe form, but conquered. The disease spread no further. It was 
8tami)cd out. 

Garland — F. A. C. Emerson, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

.Scarlet Fever — Fourteen cases. One death from phthisis. The 
bowel diseases of children have not been very prevalent. Tliere has 
been no unusual prevalence of any disease cxce[)ting scarlatina, and 
with this di.sease I have been able to trace the communication of the 
contagion from convalescents or nurse to the patients in every case 
but one. The people will not understand the necessity of care. In 
one instance scarlet fever was spread by the too earl}' return of a 
convalescent to school. 

Among hors(!S the influenza affected perhaps one-half of the num- 
ber of adult animals. 



REPORTS OF MEDICAL CORRESPONDENTS. 93 



Gorham — O'Neil W. R. Straw, m. d. 

Diphtheria — None observed. 

T\ phoid Fever — None observed. 

Seal let Fever — One ease. One death from phthisis. There have 
not been so many cases of the diarrh(eal diseases of children 
as in preceding summers. The attacks were of short duration in 
most of the cases. The most frequent causes have been poor milk 
and neglected nursing bottles. In these cases the mothers do not 
seem to understand how to take proper care of their children. 

To improve the general sanitary condition of the town, I think it 
would be a good idea to do away with the wells and in the place of 
them have Sebago Lake water. 

In the early spring we had one case of glanders, but the horse was 
killed at once and no other cases resulted. 

Gray — E. A. McCollister, m. d. 

Diphtheria — Twenty-eight cases in Gray, three fatal ; three cases 
in Raymond, none fatal. 

Typhoid Fever — Three cases. 

Scarlet Fever — Two eases. One death from phthisis in Grav, one 
in Raymond and two in New Gloucester. There has not been much 
prevalence of the diarrha\al diseases of chiMren. 

There has been no epidemic prevalence of an}- disease, except of 
diphtheria last fall and the first of the winter. The first cases were 
within fight feet of a cow stall. Some other cases were in a house over 
a very wet cellar, so that everything in the house became very damp. 
The cellar was filled with back water from a mill pond. The disease 
was conveyed by infection in the following instances. A lady nursed 
a case of diphtheria by day, returning nights where two grandchildren 
lived. In four days one child sickened of diphtheria and died in a 
week. Tiie other child took the disease about three days later than 
the first one and lived through a severe sickness. Anotlior ladv helped 
for a single day to take care of the same case and eanie down with 
the disease a week afterward. 

Greene. — Albion Pierce, m. d. 
Diphtheria — None observed. 
Typhoid Fever — None observed. 

One death from phthisis. I have not seen a severe case of summer 
complaint for the past year. 



94 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

The following is in brief the histoiy of two cases of phthisis, that 
of a husband and wife, aged about twenty-five years, in which it is 
probable that the husband contracted the disease from the wife by 
infection. The wife, who was sick first, stayed at her mother's and 
was kept in a close room with the windows closely calked, although it 
was mild weather. The husband worked at his father's, some two or 
three miles distant, where he made his home. After working through 
the da}' he would go where his wife was to take care of her through 
the night, and in the morning before eating his breakfast, he would 
return to his father's place. In about six months the husband began 
to have a throat and lung trouble, and when I was called to see him 
later I found evidences of a cavity in the left lung and that his case 
was hopeless. Just before the husband took his bed, the wife was 
removed to his home where they both died nearly at the same 
time. 

The wife was a feeble, pale-faced woman at her marriage, two 
years before the tubercular disease declared itself. She was sick 
two years. The husband's sickness began about a year after his 
wife was taken sick. Before this his health had always been sound 
and tliere had been no suspicion of tendency to lung disease ; neither 
was tliere any history of hereditary tendency further than it was said 
that two maternal aunts had died of consumption. Whether these 
were cases of tuberculosis or not is very doubtful, for en(iuiry shows 
that one had a cancer and that at last she was said to have died of 
consumption, and that the other was sick with a variety of troubles 
for twenty years. 

Greenville — H. Hunt, Jr., m. d. 

Diphtheria — None observed. 
Typhoid Fever — Four cases. 

Scarlet Fever — One case. The diarrhoeal diseases of children have 
been quite prevalent, though not of a serious character. 

Guilford — C. B. Bennett, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

No doatli.s from phthisis. Tliere has been no unuRual prevalence 
of di.seases, excepting summer complaint and wliooping cough to- 
gether. 



REPORTS or MEDICAL CORRESPONDENTS. 95 

Harmony — Wm. McLaughlin, m. d. 

Diphtlieria — None observed. 

Typhoid Fever — Four cases in Harmon}' ; two in Wellington. 

From phthisis one death in Harmon}' and one in Wellington. 
There has been quite a prevalence of tlie diarrhoeal diseases of chil- 
dren. 

Two families, having two small children each, lived in the same 
house. The last of August and the first of September all four of 
these children were attacked Avith diarrhcea and dysentery. I treated 
them several days without apparent relief when I discovered that 
the}' were using water from a well near the house where it received 
the drainage from the sink. I ordered them to cease to use the 
water from this well, and to get the water from a spring and boil that 
before it was used. The children then began to improve and were 
well in a few days. 

Harpswell — G. A. Haklow, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Three cases, none fatal. 

Scarlet Fever — Four cases, none fatal. One death from phthisis. 
The summer complaint of children has been very prevalent, causing 
two deaths. I think the most potent causes have been the hot 
weather and improper food. 

I had one case of typhoid fever, caused by a putrid cat in the well. 

Harrington — G. H. Walling, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Two cases. 

Scarlet Fever — One case. From phthisis, one death in Harrington 
and one in Cherryfield. The diarrha^al diseases of children have 
been very prevalent and two deaths resulted in Columbia. Unsuit- 
able food was the most frequent cause. 

A student came home sick with typhoid dysentery. He recovered 
and soon afterward a brother was attacked, followed by two sisters 
and his mother. All recovered. Evidence pointed to contagion. 



96 STATE BOAED OF HEALTH — SECRETARY'S REPORT. 

Hartland — E. A. Bean, m. d. 

Diphtheria — Three cases, no deaths. 

Typhoid Fever — None observed. 

One death from phthisis. The summer complaint among children 
has been ver3- prevalent, caused mostl}- by bad drinking water, im- 
proper diet and hot weather. 

Hartland — David R. Brown, m. d. 

Diphtheria — One case. 

Typhoid Fever — None observed. 

No deaths from phthisis tiiis year. The diarrhoeal diseases of chil- 
dren have been prevalent, the cases caused by the extreme changes 
in the temperature. There has been no epidemic, except of mumps. 

Hiram — C. E. Wilson, m. d. 

Diphtheria — None observed. 

Tvphoid Fever — One case. 

One death from phthisis. There has been quite a prevalence of 
children's bowel complaint with one death. Causes, hot weather and 
low condition of the water. Tonsillitis was prevalent the last of the 
winter and in the spring. Measles have prevailed quite extensively, 
but in a rather mild form. E^nteric troubles with typhoid symptoms 
have been somewliat frequent, but the cases terminated suddenly 
about the fourth da}'. I have noticed these troubles occur most 
frequently where the water supply is poor, and where there is un- 
suitable food and a lack of personal cleanliness. 

Houlton — C E. Williams, m. d. 

Diphtheria — Nine cases, two fatal. In New Limerick, two cases, 
one fatal. 

Tyi)hoid Fever — Five cases, one fatal. 

From phthisis, one death in Houlton and one in Monticello. The 
diarrlucal diseases of children have not been so prevalent this sea- 
son as they were in the fall of 1.S85. One death in Houlton. Im- 
proper f<M;d and atmospheric conditions arc tlie more frequent causes. 

For the improvement of the sanitary condition of the town a bet- 
ter system of village drainage is sorely needed. 



REPORTS OF MEDICAL CORRESPONDENTS. 97 

In the spring an influenza prevailed among horses throughout the 
county. One case of diplitheria was derived at school from a seat- 
mate. Tia-ee cases of the same disease were due to handling a dead 
child. 

HoultOn — T. J. FiTZMAURICE, M. D. 

Diphtheria — One case, fatal. 

Typhoid Fever — In Houlton, two cases, recovered ; Smyrna, four 
cases, one fatal. 

From phthisis, one death in Houlton, two in Smyrna. 

There has been very little of the diarrheal diseases of children as 
compared with former years. 

Industry — "NYm. C. Hatch, m. d. 

The year ending October 1st, has been an unusually healthy one in 
this town. I believe there has not been a case of diphtheria, scarla- 
tina, or typhoid fever during the year. So far as I can learn not 
more than two or three persons have died from phthisis during the 
year. The diarrha^al diseases have not been so prevalent as in some 
years past. 

Pneumonia has without question been the most prevalent disease, 
and among the aged especiall}', has proved very fatal. Carelessness 
and insufficient protection against sudden change are the probable 
causes of man}' cases of this disease. 

I do not believe that over 15 per cent of the population have been 
successfully vaccinated within the last twenty years. Careful obser- 
vation has led me to believe that the practice of using humanized 
vaccine virus cannot be too strongly condemned. Several cases have 
recently come under my notice where its use has caused serious mis- 
chief. 

Jonesport — J. A. Walling, m. d. 

Diphtheria — None. 

Typhoid Fever — None. 

Scarlet Fever — One hundred and thirty cases, two fatal. 

Two deaths from phthisis. The diarrha^al diseases of children 
have been quite prevalent, due largely to impure water and unsuit- 
able food. Mumps and whooping cough have also been prevalent. 



98 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

The first case of scarlet fever proved fatal. It was not considered 
scarlet lever at the time, but the next cases were in the family of 
those who attended the funeral, which was a public one. A young 
man went to work for a mau whose family had had the scarlet fever 
a month or two before. He contracted the disease in a mild form. 

Kitlery — A. W. Johnson, m. d. 

Diphtheria — Six cases, none fatal. 

Typhoid Fever — One case, recovered. 

Scarlet Fever — Four cases, none fatal. 

From phthisis, one death. The various diarrhojal diseases of chil- 
dren have not been ver}' prevalent ; one death. Dentition and over 
feeding seem to be the most common causes. 

Leiviston — A. M. Foster, m d. 

Diphtheria — Six cases, two fatal. 

Typhoid Faver — One case, not fatal. 

From pulmonary phthisis, two deaths in this cit^' and one in Au- 
burn. There has been only an average prevalence of the diarrhoeal 
diseases. A frequent cause of these diseases is some radical 
change in the location, diet or drink, like moving into the city from 
the country, or from dry and healtliy places to damp and unhealthy 
ones ; also eating stale vegetables. 

Some of the cases of summer complaint were peculiar in having 
the nervous .system profoundly affected. There was severe abdomi- 
nal pain tliat resembled neuralgia, with great prostration and a ten- 
dency to daily exacerbations. I think some of the cases were caused 
by inhaling foul gases from cesspools and neglected privies. 

Duiing the autumn and winter months (1885) nieasles of a severe 
type prevailed, also several cases of severe neuralgia, seemingly 
almost epidemic. Several classes of cases have with me assumed 
a tend(!ncy to periodicity and 1 attribute it to one or two badly 
drained localities, especially a place between P'ranklin and liates 
streets. 

A vast number of the houses in this city are not connected with 
the city sewers and have the old filthy privies, in many instances 
complete nui.sances. Sufficient care is not taken to properly dispose 
of the city garbage. It is dumped in close proximity to a quarter 
where a large part of the foreign population reside. 



REPORTS OF MEDICAL CORRESPONDENTS. 99 



Lewiston — M. C. Wedgewood, m. d. 

Diphtheria — None observed. 

Typhoid P^ever. — Ten cases. 

Scarlet Fever — Six cases. One death from phthisis. Tiie di- 
arrheal diseases of children have not been very prevalent. The 
most frequent causes have been bad feeding and poor nursing. 
Some cases of scarlet fever have been observed which were due to 
the too earl}' readmission of scholars that have had this disease. 

Leioiston — E. W. Russell, m. d. 

Diphtheria — Four cases. 

Typhoid Fever — Four cases. 

Scarlet Fever — Two cases. From phthisis one death. The sum- 
mer complaint of children has been quite prevalent. The most fre- 
quent cause has been imperfect nourishment. 

Liberty — E. A. Porter, m. d. 

Diphtheria — None observed 

Typlioid Fever — Two cases in Liberty and one in Appleton. 

From phthisis two deaths in Liberty, one in Searsmont. The 
diarrhd'al diseases of children have not been ver}' prevalent. 

The typhoid fever case in Appleton originated at a boarding-house in 
Warren, and at present I have another case just come home from there. 
The cases in Lil>erty, I think, were due to the well water, it being very 
low and the well located in one corner of the barnyard. At the 
same place, besides the two cases reported, 1 am now treating two 
more, and still another is threatened with the disease. 

Limington — S. M. Bradbury, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case. 

One death from phthisis. Not many cases of the diarrlueal dis- 
eases. Among sheep, the disease which the people call tlie scab has 
prevailed extensively and has ruined some flocks. 

Some years ago small-pox was taken by a man by putting on a 
pair of gloves that had been worn by a man who died with the small- 
pox The gloves had been put away in the barn one year when they 
were put on. 



100 STATE BOARD OF HEALTH— SECRETARY'S REPORT. 

Lincoln Center — W. D. Bullard, m. d. 

Diphtheria — Two cases. 

Typhoid Fever — Two cases. 

Scarlet Fever — Five cases. The summer complaint has not been 
very prevalent, and there have been but ver}^ few fatal cases. As 
causes I would mention influence of the weather, injudicious diet, 
defective ventilation and cesspools. For a sanitary improvement, I 
would suggest doing away with the sink spouts, 

Lincoln Center — L. H. White, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

Scarlet Fever — Four cases in Chester. This disease was brought 
from Lewiston b}- visitors. From phthisis, two deaths in Lincoln, 
one in Medville Plantation. There have been man^' cases of summer 
complaint, but they have been very mild ; the most frequent cause is 
to be referred to the water. 

The sanitary condition of our locality is very good, and there have 
been no cases of the contagious diseases arising from any sanitary 
defects. 

Linneus — Robert Boyd, m, d. 

Diphtheria — Eleven cases in Linneus, two fatal, and three cases 
in Oakfield, and four in Haynesville, none fatal. 

Typhoid Fever — Three cases in Linneus, two in Amity, none fataL 
One death from phthisis. Not many cases of the diarrhoial dis- 
eases have occurred. 

Litchfield — Enoch Adams, m. d. 

Diphtheria — Three cases. 

Typhoid Fever — One case. 

Scarlet Fever — Two cases. 

From phthisis, four deaths. The summer complaints of children 
have not ])cen very prevalent. In the early part of the 3'ear I ob- 
served about thirty cases of measles. One case of cholera morbus 
in May resulted from eating fermented canned tomatoes. As a whole, 
the year has been a healthy one. 



REPORTS OF MEDICAX. CORRESPONDENTS. 101 

Litchfield — Cyrus Kindrick, m. d. 

Diphtheria — No cases. 

Typhoid Fever — None. 

Two deaths from phthisis. The diarrha?al diseases not very preva- 
lent. Causes, teething, improper food and sudden changes in the 
weather. 

Litchfield — I. W. Gilbert, m. d. 

Diphtheria — None observed. 

Typlioid Fever — Three cases in Wales. 

Scarlet Fever — One case. 

Livermore Falls — Henry Reynolds, m. d. 

Diphtheria. Two cases in East Livermore, one in Ja}'. 
T3'phoid Fever — In East Livermore, one case, in Jay one case. 
One death from phthisis. The diarrhoeal diseases of children not 
so prevalent as usual. 

Loveil — C. P. Hubbard, m. d. 

Diphtheria — One case. 

Typhoid Fever — None observed. 

From phthisis one death. There have been but few cases of the 
diarrlufal diseases, caused mostl}' by the eating of unripe fruit. 
There has not been so little sickness in town for years as there has 
been this summer. 

Lubec — E. H. Bennett, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case. 

Scarlet Fever — Tliirty cases ; one death from the sequels of the 
disease. Five deaths from phthisis. The various diarrhcval diseases 
of children have prevailed much more than usual, witli two deaths. 
Bad drinking water has been the principal cause ; bad drainage often 
pollutes the water in this town. 

Scarlet fever was very prevalent, especially through the summer. 
It was brought into town l)y a boy who was taken on a visit to East- 
port to a house where the disease had been. Imprudence and care- 
lessness has been the prime cause of the disease. 
• 



102 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

For improving the general sanitary condition of tlie place, it is 
important that the people be taught to appreciate cleanliness, to 
know the importance of drainage, ventilation, pure water, etc. 

Scarlet fever was spread more b}- school children than otherwise. 
When one scholar was taken it was sent to school unless too sick to 
go. Several were sent home with well marked rash out. 

Luhec — H. S. Delamere, m. d. 

Diphtheria — None. 

Typhoid Fever — None observed. 

Scarlet Fever — Seventeen cases, none fatal. 

From phthisis one death. Quite a prevalence of the diarrhoeal 
diseases. The principal cause I would refer to bad drinking water, 
the season having been unusually dr\', and the wells low. 

The epidemic of scarlet fever of a mild type was spread by con- 
tagion. The isolation of the cases would have prevented the spread 
of the disease in this locality. 

A great deal could be done to improve the sanitary condition of 
the town, such as attention to the relative positions of wells to 
privies, sink drains, stables, etc. The wooden underpinnings under 
many of the houses might be replaced with stone or brick with 
advantage to health. 

Lyman — E. Hurd. m. d. 

Diphtheria — None observed. 

T^'phoid Fever — None observed 

No deaths from phthisis. The diarrhoeal diseases were quite 
prevalent. The more common causes were heat, teething, change 
of diet, bad nutrition, insanitary localities. Whooping cough has 
prevailed to some extent. 

Machias — B. L. Dresser, m, d. 

Diphtheria — None observed. 

Typhoid Fever — Three mild cases. 

Scarlet Fever — One case. 

From phthisis six deaths. The diarrhoeal diseases have l)een 
unusually frequent and severe. 1 think tlu-; i)riiK;ipal cause has been 
the dryness of the season. 



REPORTS OF MEDICAL CORRESPONDENTS. 103 



Madison — W. G. Saavykr, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Four cases in Starks. 

From phthisis one death in Starks. There has been a very great 
prevalence of the diarrha'al diseases. The principal causes have 
appeared to be sudden changes in the temperature and improper 
articles of diet. 

I attended three cases of typhoid fever in one family where I be- 
lieve the disease originated from polluted water. The soil is mostly 
gravel to a depth of from two to four feet ; then there is what is 
termed "hard pan," six inches to one foot below which is loose 
sand. The surface water descends to hard pan, then seeks a level 
or runs into the well, which is situated within five or six feet of the 
barnyard and twenty-five or thirty feet from the priv}-. 

Madison (East) — A. E. Farnham, m. d. 

Diphtheria — Twenty-two cases. 

Tj'phoid Fever — One case in Solon. 

Scarlet Fever — Four cases in East Madison, three in Solon. From 
phthisis there have been five deaths. The diarrhceal diseases have 
been unusually prevalent, with three deaths. As causes there have 
been observed, lack of care on the part of mothers, allowing children 
to remain out of doors evenings and get chilled, unripe fruit, and 
especiallj' using long tubes in the nursing bottle, in which the milk 
decomi)Oses and sets up disturi)ances of the stomach and bowels. 

Diphtheria was spread, in two instances, by contagion at public 
funeral. 

The following ease of arsenical poisoning came under my observa- 
tion : 

A small boy aged three years was taken suddenly ill, and presented 
symptoms of arsenical poisoning. I could not obtain any informa- 
tion from the child's parents. I was convinced that the child was 
poisoned, and I treated him for arsenical poisoning. He was exceed- 
ingly ill for three or four days, and his life was despaired of during 
this time. After a few days he began to get better, and in the course 
of a week or ten days was in his usual health. I asked so many 
questions of the parents about what the child had eaten and if there 
had been Paris green around, etc., etc., that they got nearly out of 



104 STATE BOARD OF. HEALTH SECRETARY'S REPORT. 

patience with me. A few weeks after the child recovered, the father 
brought me a green paste-board box which the little one had pla3'ed 
with. One corner of the box was white where the child had sacked 
the paint off. By moistening the finger and rubbing the box, the 
green paint would roll up under the finger. This explained the 
child's sickness. 

Maphton — C. E. Dow, m. d. 

Diphtheria — Four cases. 

Typhoid Fever — Fourteen cases and one death. 

No deaths from phthisis reported. The diarrhoeal diseases of 
children have not been very prevalent. Their cause here is sanitar}' 
neglect 

To improve the sanitary condition of the place I would suggest 
the importance of having a board of health for Mapleton. No one 
seems to take much interest in sanitary matters here. Many of the 
privy vaults are never looked after once in five years. Two years 
ago we had typhoid fever in the same house where I have now 
reported cases. At that time the fever ran forty days and yet the 
family never seemed to learn to have the privy arrangements looked 
after. The fever cases here may be credited generally to neglected 
privy vaults. 

Mechanic Falls — C. H. Tobie, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Thirteen cases, one fatal. 

Scarlet Fever — Two cases. The diarrlutal diseases have not been 
very prevalent. The cases that have occurred have been due to 
unhvgienic conditions. 



■■JO 



Mercer — V. K. Perkins, m. d. 



Diphtheria — Five cases. 
Typhoid Fever — Two cases. 
One death from phthisis. 



Mexico — H. J. Binford, m. d. 



Diphtheria — None observed. 
Tyi)hoid Fever — One case in Byron. 



REPORTS OF MEDICAL CORRESPONDENTS. 105 

Scarlet Fever — One case. No deaths from phthisis. Not many 
cases of the diarrha-al diseases. It has been exceptionally healthy 
here this 3'ear. 

During the latter part of last winter the distemper or strangles 
prevailed among horses and several valuable young animals died. 

Monroe — J. J. Sewaix, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Seven cases. 

Scarlet Fever — Two cases. Three deaths from phthisis. Eight 
or nine cases of cholera infantum, with two deaths. The more fre- 
quent causes have been improper diet and bad water. 

Mount Vernon — Cyrus Burbank, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

No deaths from phthisis. There have been but a few cases of 
summer complaint, one death in Vienna. We have been remarka- 
bly exempt from diseases the past year. 

Mount Vernon — H. F. Shaw, m. d. 

Diphtheria — Three cases iu Vienna. 

Typhoid Fever — None observed. 

Scarlet Fever — Three cases in Belgrade, one death. 

From phthisis three deaths in Mount Vernon, one in Rome. 

The three cases of scarlet fever which I report in Belgrade were 
three children in one family. A few days before the disease broke 
out, a gentleman, whose children had been sick with scarlet fever be- 
fore he left home, came to board with the family. At the time of 
mj' first visit this man had a severe pharyngitis, with abscess in the 
throat. The mother of the children, too, had a similar throat trouble, 
with abscess, which I diagnosed as a mild form of scarlatina. 

Newfield — Stephen Adams, m. d. 

Diphtheria — Three cases. 

Typhoid Fever — None observed. There has not been a case of 
typhoid fever in town since 1868, except two or three imported cases 
in young men who came home sick. From phthisis no deaths. But 
few cases of summer complaint. 



106 STATE BOARD OF HEALTH SECRETARY'S REPORT. 



New Portland — S. A. Bennett, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One ease in New Porthmd, two in New Vine- 
yard. One death from phthisis. Tiie diarrhoeal diseases of children 
have not been Tery prevalent. I think man}' of the cases have been 
caused b}' the unusually hot weather. 

New Sharon — H. R. Corson, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Two cases at the present time. 

From phthisis no deaths. There has been no great prevalence of 
the diarrha?al diseases. The few cases noted seem to be due to 
changes in the temperature. 

Needed sanitary- improvements are better ventilation and a sup- 
ply of pure water. In the houses of many of the families of the 
poorer class a ver}' strong odor from the priv}' is perceptible in any 
part of the house. The members of these families seem to be 
sickly, without any serious disease. 

North Berwick — F. B. Mourill, m. i>. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

Three deaths from phthisis. The diarrhoeal diseases have been 
quite prevalent, with two deaths. The cases have been caused 
mostl}' by an improper dietary. Whooi)ing cough and measles have 
prevailed in the schools. 

North Berwick — J. O. McCorrison, m. d. 

Diphtheria — Three cases. 

Typhoid Fever — Four cases. 

Scarlet Fever — Five cases. From jjulmonary phthisis five deaths ; 
seven or eight other deaths, in the hands of other physicians. 
There have been but very few cases of the diarrha'al diseases of 
children, but there were two fatal cases that were pronounced chol- 
era infantum. Under ray observation these diseases have been due 
mostly to bad sanitary arrangements, poor food, dampness and 
imperfect ventilation. 

Rheumatism, whooping cough and bronchitis have also occured. 



REPORTS OF MEDICAL CORRESPONDENTS. 107 

No cases of the long retention of the vitality of contagion have 
been observed, unless it was in one case of scarlet fever. Some 
twelve months previously a cliiltl had been sick in the family and 
they had not taken proper precautions in regard to fumigating. 

Norway — B. F. Bradbury, m. d. 

Diphtheria — One case. 

Typiioid Fever — Four cases. 

From phthisis, two deaths. The diarrhoeal diseases have been ver}' 
prevalent, with one death. The principal cause, I think, is improper 
food. Cases of simple continued fever have been especiall}' preva- 
lent, nearly all having been on the line of excavation for the new 
water works ; also, three of my four cases of typhoid fever were on 
the same line of excavation. 

A local board of health and proper sewerage would improve the 
sanitary condition of the place. 

Noricny — E. J. No yes, m. d. 

Typhoid fever has been especially prevalent this season, arising, 
no doubt, from the filthy condition of the almost stagnant stream 
which (lows through our village, receiving the filth from the ditferent 
branches of manufacturing, and furnishing an odor, on warm eve- 
nings, almost unbearable. The only thing or method I could suggest 
to improve the sanitary condition of the town would be a good sys- 
tem of sewerage. 

Oakland — D. E. Parsons, m. d. 

Dii)htheria — One case. Contracted at a funeral in "Waterville. 

Typhoid Fever — Two cases. 

No deaths from phthisis. There have not been many cases of 
summer comphiint. 

A thorough inspection of the sanitary condition of the town is 
needed, in order to prevent outbreaks of diseases which will result 
from its present condition. 

Oxford — A. L. Hersey, m. d. 

Diphtheria — None observed. 
Typhoid Fever — Three cases. 



108 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

Scarlet Fever — Four cases. One death from phthisis. The diar- 
rhoeal diseases not very prevalent ; the cases caused mostly by im- 
proper food. A better water supply will improve the healthfulness 
of the place. 

From the use of bad water the members of a famil}'^ were affected, 
annually, for several years with gastric fever. After a change in 
the water supply was made, no cases occurred. 

Paris {SguIIi) — O. N. Bradbury, m. d. 

Diphtheria — One case. 

Typhoid Fever — None observed. 

From phthisis one death. There have been many cases of the 
diarrhoeal diseases in children, mostly caused b}' improper feeding. 
Simple continued fever of a bilious type has been quite common, the 
cause of which is probably to be referred to the water suppl}'. 
Whooping cough has prevailed in the schools. 

Paris {/South) — Horatio Woodbury, m. d. 

Diphtheria — No cases. 

Typhoid Fever — Three cases. 

Scarlet Fever — Four cases. 

From phthisis no deaths. Cases of summer complaint have been 
quite frequent, and two deaths have occurred. Our sanitary condi- 
tions would be improved by neatness as regards back yards, obscure 
alleys, sink drains and cellars, and the cleaning out of privj' vaults 
as often at least as once a year would be a great improvement. 

Paris ( West) O. K. Yates, m. d. 

Diphtheria — No cases. 

Typlioid Fever — Seven cases. Duration of fever from twenty- 
three to tliirty-fivc days. 

Scarlet F(,'Vor — One case. 

Two deatlis from phthisis. The summer complaint of children 
has been quite prevalent but not of a severe type, and has been 
caused mostly by indigestion, teetliing and (mating of unripe fruit. 

In the case of my scarlet fever patient, a relative came from Mas- 
sachusetts, whose children six weeks l)ei"ore had nicovered from 
scarlet fever. It was evident that tliis case was from exposure to 
infected clothing. 



KEPORTS OF MEDICAL CORRESPONDENTS. 109 

Paris {West) — F. H. Packard, m. d. 

Diphtheria — One case. 

Typhoid Fever — Three cases. 

Four deaths from phthisis. The diarrhoeal diseases have not been 
very prevalent. These cases have been caused almost entirelj' by 
bad feeding. 

The wells of many of the families are too near to out-buildings, 
sink spouts, and other sources of filth of all kinds. The cellars are 
not looked after carefully enough. Whooping cough and measles 
were prevalent in the schools. 

In the case of a child who, while riding home from a visit to a 
relative, was furnished with clothing to protect it by a family in 
which there had been scarlet fever six weeks previously, the child 
took the disease and died and gave the disease to another child. 
In the family whence the clothing came the disease assumed a very 
mild form. In the case of the child mentioned, death occurred on 
the third day and the next case had the disease in a severe form, 
but recovered. 

Parkman — J. C. Butterfield, m. d. 

Diphtheria — Eight cases, three fatal. 

Typhoid Fever — None reported. 

The diarrhoeal diseases of children quite pi-evalent, with one fatal 
case. Most of the cases were caused by teething. Several cases 
of cholera morbus in adults, one of which was very severe and 
seemed like Asiatic cholera. When I was called the patient was in 
a state of collapse, with cramp in legs, black vomit, cold sweat, and 
with pulse imperceptible. Died in about four hours. Tonsillitis and 
acute bronchitis have been quite prevalent. 

An earlier putting on of flannels would prevent much sickness of 
this kind. 

Diphtheria was brought in clothing from Boston, by a young man 
and his brother who had been attending him. 

Parsonsfield {East) — J. A. Kennard, m. d. 

Diphtheria — None reported. 
Typhoid Fever — None reported. 

The diarrhwal diseases of children have been very prevalent, 
caused mostly by changes of temperature and improper food. 



110 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 



Patten — F. F. Bigelow, m. d. 

Diphtheria — One ease in Patten, and one case in Crj'stal Planta- 
tion, traceable probably to the case we had in this town. 

Typhoid Fever — Two cases in Patten, and two in Mt. Chase Plan- 
tation. 

Pemaquid — W. S. Brainerd, m. d. 

Diphtheria — One fatal case in Bristol. 

T3phoid Fever — None observed. 

Six deaths from consumption. The diarrhceal diseases of children 
were very prevalent during September ; one death. Errors in diet 
have usually been the exciting cause. 

Pembroke — J. C. Rogers, m. d. 

In December, 1870, I was called to see a child sick with scarlet 
fever. The rash had disappeared, for the child had been sick a 
fortnight. The neck and throat were fearfully' swollen, the latter 
in a state of decomposition. "While I was engaged in looking down 
its throat, it strangled and couglied a quantity of matter in my 
face. I contracted the disease and my three cliildren took it from 
me, and one of tlieni died, having been sick about thirty hours. 

The father of the cliild was a seaman. On his way home, he 
stopped at Portland, called on a friend whose famiW were sick with 
scarlet fever, and, consequently, carried home the contagion in his 
clothes to his child. From that one case, I can trace thirty-six 
cases directly, six of whom died. The child's aunt visited the place 
frequently, and although she lived four miles from there, her chil- 
dren contracted the disease. All that came in contact with my fam- 
ily, who had not previously had it, took it — even to my aged mother. 
The physician who attended the aunt's children boarded at the hotel. 
A little girl of ten years, with whom he used to play, contracted the 
disease and died. My niece was stopping with me at the time that 
I and my children were sick. Some weeks afterwards, she went to 
the neighboring town of Charlotte and in about a week's time it ap- 
peared in the family. Since then scarlatina has appeared, at times, 
in families, but not with such malignity. Last year it broke out in a 
neighborhood about three miles from the village. The disease was 
contracted at Eastport, where it prevailed, by a young woman who 



REPORTS or MEDICAL CORRESPONDENTS. Ill 

worked in one of the sardine factories. It went through the family 
of seven, all of whom recovered. The necessary precautions hav- 
ing been enforced, the disease did not spread beyond this family. 
Only two cases occurred, no deaths. How it originated, I do not 
know, but judge it must have been brought by some visitors from 
Eastport. I am of the opinion that small-pox, measles, and scarla- 
tina are always propagated by infection and never originate of them- 
selves. 

Diphtheria has made its appearance occasionally, since that fearful 
epidemic of 1800-61. It appears in families who live apparently in 
the most healthful localities, as well as in those who live surrounded 
bj' filth and all kinds of impurities. So its cause or origin has been 
a puzzle to me. Of its contagiousness I have no doubt, after it has 
once made its appearance, but to trace the origin of the cases that 
have occurred in my practice to contagion is impossible. Although 
it has prevailed almost every 3'ear since 18G1, I cannot trace the 
origin of a single case to contagion, except perhaps one. 

In December, 1876, a boy who lived in the town of Perry visited 
a family in Eastport, some of whom were sick with diphtheria. He 
contracted the disease, had a light run and got well. His sister, 
aged sixteen, took the disease and in tluee days was dead. The 
next summer another sister came from Massachusetts, occupied the 
deceased sister's room, in which she was sick and died. She also 
took diphtheria, and after five weeks sickness died. She was twenty- 
two years old. 

During the time the Pembroke iron works were in full operation, 
there was no typhoid fever in this village, although cases occurred 
outside. Now, since they have suspended work, the most of the 
cases appear in the village and along the stream. There was a 
period of about eighteen years during which there was not a single 
case within a ra<lius of a mile of the iron works, except one, and 
that was contracted in Massachusetts. I can only account for this 
in the disinfecting influence of the smoke and cinder. The sanitary 
condition has not changed. The water is used from the same wells ; 
the soil has undergone no change ; in fact, everything is the same, 
except the buildings are older and dilapidated and many of them 
are unoccupied. 

Within a period of four years, I have had fifty-eight cases of 
typhoid fever ; no deaths. The most of these cases were contracted 
from some one who had been stricken down with it first. 



112 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

Of the effects of filthy siuk-spouts on the origin or cause of this 
disease, a good illustration came under my observation last year. 
The sink and sink-spout were about the same as those in general 
use. The spout became filled with filthy accumulations, and one of 
the men cleaned it out. While in the act the stench became so great 
that it several times drove him awa^'. and permeated the whole house. 
In a few days he and three others of the inmates were down with 
typhoid fever. They all recovered after a severe attack. 

Penobscot — E. A. Sprague, m, d. 

Diphtheria — None reported. 

Typhoid Fever — None reported. 

The summer complaint of children has been quite prevalent, with 
two deaths. The principal causes have been heat and bottle feed- 
ing. The sanitar}' condition of the place can be improved by the 
distribution of sanitary works for the people. 

Phillips — H. B. Palmer, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case in Phillips, and one in Avon. 

One death from phthisis. The diarrhoeal diseases of children have 
been prevalent, with one death in Avon and one in Rangeley. Con- 
tinued hot weather and improper feeding have acted as causes. "We 
have had quite a thorough epidemic of measles. 

Of the diseases of animals there have been a limited number of 
cases of pinkeye among horses. 

Pittsjield — T. M. Griffin, m. d. 

Diphtheria — Four cases, one fatal. 

Typhoid Fever — Two cases, none fatal. 

Two cases of phthisis, with one death. The various diarrhoeal dis- 
eases of children have been quite prevalent, with one death. The 
more frequent causes have been the use of nursing bottles, bad hy- 
gienic surroundings, and want of care. Bad drainage has also been 
a great cause. For improving the sanitary condition of our town I 
would suggest a continuation of the good work now going on in fill- 
ing up stagnant pools and draining where it can be done. Such 
matters have received a good deal of attention of late and will doubt- 
less bring about good results in the near future. 



REPORTS OF MEDICAL CORRESPONDENTS. 113 

PiUsjield — F. J. Taylor, m. d. 

Diplitberia — Six cases. 

Tyitlioid Fever — Five cases, two fatal. 

One death from phthisis. There have been many obstinate cases 
of summer complaint amongst the children, with one death from 
cholera infantum. The heat, improper food, and impure air I think 
have been the principal causes. 

I have been enabled to trace all my cases of typhoid fever to either 
polluted drinking water or bad drainage and filth}- sink spouts. There 
were three cases of typhoid fever in one family due to a sink drain 
which ran within six or eight feet of the well. The ground is so 
level that the water does not drain off and stands and soaks into the 
ground. The drainage of the hog-pen and privy are also into this 
shallow drain. 

Piltston — A. C. Wright, m. d. 

Diphtheria — None reported. 
Typlioid Fever — None reported. 

Summer complaint among children has been very prevalent. Filthy 
nursing bottles and teething have been frequent causes. 

Portland — Geo. C. Burgess, Sec. Board of Health. 

In response to j'our request, I send for your use a few items of 
our work during the past season, beginning May 1st, when our pres- 
ent health officer, Mr. J. H. Sayward, took office. 

Our method has been to visit various localities suspected to be un- 
sanitary, either from complaint made, or from knowledge obtained 
otherwise l)y the health officer. 

In the eight months, the officer has made 2,893 such visits, 

A prominent cause of complaint has been on account of those 
intolerable nuisances, even in their best state, the accumulative 
privies, nearly eight hundred of which were found to be in such a 
condition as to require immediate attention, by cleaning, disinfect- 
ing, «S:C., &,(i. 

One hundred and forty-six cellars were found in such bad condition 
as to require action on part of the health officer. 

It is perhaps proper to say that many times owners of property 
are not aware of tlie foul condition of their premises, until their 
attention is called to it by the officer. 8 



114 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

Swine have been removed from forty-four places, and it is not 
known to the Board that there is any place within the cit}'^ limits 
where swine are kept, except one, and complaint was onlj' made of 
that yesterday. 

Through the efforts of the health officer, one hundred and lift}'^ 
privy vaults have been abolished, and good and sutflcient water 
closets substituted in tlieir places. 

Stagnant pools have been filled, sink drains, cess-pools and such 
like nuisances have been put into the best condition that such things 
can be made to assume. 

In addition to the above-mentioned work, the officer has made a 
house-to-house inspection of a limited section of the cit3', containing 
two hundred and eighty-one houses, and has returned to the Board a 
report of the following particulars. 

Whether supplied with privy or water closet, and condition of 
each, state of traps, &c., condition of drains, and whether connected 
with the public sewer or with a cess-pool ; condition of 3'ard, and 
whether the house is supplied with water from a well, or from the 
water company's works. If from the former, how near the well is to 
the privy or cess-pool. 

This work I hope to see extended as a basis of more thorough 
woi"k later on. The particular portion of the cit}' where this inspec- 
tion was had, was over a loose and coarse gravel, undei'laid with a 
thick bed of bowlder clay. 

Almost at random I take from the notes the following entries. 

House of Mrs. C. Water closet connected with the sewer, but 
water for household purposes is obtained from the well, which is sit- 
uated twelve feet from a privy. 

House of Mr. E. has a privy and uses water from a well twenty 
feet from it, both in gravelly soil, «fec., &c., &c. 

You know how little law we have to work under, and in view of 
this I think we have accomplished a great deal of good work this 
season. 

We need a law regulating the plumbing of houses and the laying 
of private drains connecting houses with the public sewers; this I 
hope your board will accomplish the coming session. 

Portland — C. G. Adams, m. d. 

Diphtheria — Three cases. 
Typhoid Fever — Two cases. 



REPORTS OF MEDICAL CORRESPONDENTS. 115 

From phthisis, four deaths. The diarrha^al diseases of children 
have not been very prevalent. The more frequent causes have been 
heat, teething and injudicious feeding. 

Portland — T. A. Foster, m. d. 

, Diphtheria — Six cases. 

Tvi)hoid Fever — One case. 

Three deaths from phthisis. The diarrha^al diseases of children 
have not been very prevalent. The most common cause is improper 
feedinj;. 

Cleaner and dryer cellars and better drainage and ventilation would 
improve the sanitary conditions. 

Portland — J. M. Gassaway, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Four cases in East Deering, one fatal. 

From phthisis, four deaths in East Deering. The diarrha\il dis- 
eases of children have not been especially prevalent; most common 
cause improper food, especially of bottle-fed babies. 

Three cases of simple facial erysipelas, possibly attributable to a 
case treated in the same house two years before, though disinfection 
was thoroughly made with sulphurous acid gas after each case. There 
was no other assignable cause. 

A case of lead poisoning, as follows : An elderly man much 
troubled with obstinate constipation, intense colic, gingival blue 
line, and wrist-drop was greatly comforted with sulphate alum, 
opium, and iodide potash mixture. The drinking water used by 
this gentleman and his elderly wife was from a rain-water cistern 
well cemented within, and drawn by a pump through a lead pipe, 
which had been in position "some years." The woman did not suf- 
fer so much as the man. Both recovered. 

Portland — F. H. Gerrisii, m. d. 

Diphtheria — Two cases, one fatal. 

T3'phoid Fever — None observed. 

Scarlet Fever — One case. The various diarrhrral diseases of chil- 
dren have not been very prevalent. Diphtheria has been especially 
prevalent the past year, and the details will doubtless be furnished 
by those who iiad the patients. There was one case in which I think 
that diphtheria was contracted at a funeral. 



116 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 



Portland — J. L. Horr, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Six cases, two fatal. 

Two deaths from phthisis in "Westbrook. The diarrhceal diseases 
of children have been ver^' prevalent, and four deaths have resulted. 
vSummer heat and improper feeding have been the more frequent 
causes of these diseases. 

Portland — F. P, Scully, m. d. 

Diphtheria — Four cases. 

Typhoid Fever — Fort}' cases in Portland, one in Deering. 

Scarlet Fever — Five cases. From phthisis, ten cases observed. 
I have seen but very little of the diarrhceal diseases of children. 
The principal cause of these diseases is over-nui*sing and the long 
rubber tube attachment to the nursing bottle, aptly called the "mod- 
ern Herod." 

As sanitary measures for the city, I would recommend better 
trapping of sinks and other fixtures with such forms of traps as do 
not admit of siphonage, and the interdiction of the use of water 
from wells situated at the foot of hills so that the}' catch the soak- 
age from privies and stables above. 

One point, I believe, should be considered by physicians which 
seems to be generally overlooked, — that is, the germ theory of phthisis. 
In these days when we can make the diagnosis of phthisis b}' means 
of a microscopical examination of the sputa of patients, even dis- 
pensing with the physical examination of the luugs, it seems proper 
to call attention to the danger of sleeping with phthisical patients 
and of neglecting the ventilation of the rooms, and to the need of 
disinfecting precautions. 

PoHland — Chas. D. Smith, m. d. 

Diphtheria — Ten cases. 

Typhoid Fever — Seven cases, two fatal. 

Scarlet Fever — Six cases in Portland, four in Deering. Twelve 
deaths observed from phthisis. The diarrhfcal diseases of children 
have been quite prevalent, and I have known of three deaths result- 
ing from them. The most common cause seemed to be the poor 
quality of the food, and sudden changes of temperature. 

Diphtheria has been especially prevalent, and I am satisfied that 



EEPORTS OF MEDICAL CORRESPONDENTS. 117 

eighty per cent of. all cases have been contracted b}' direct conta- 
gion. Suggestions for lessening the prevalence of this disease are 
isolation of the patients, disinfection of the discharges, fumigation 
of infected rooms and clothing, prevention of the mingling of nurses 
and attendants with other people, and the prohibition of public fun- 
erals. These measures are now being carried out in this city, our 
board of health having succeeded in securing from the city gov- 
ernment an ordinance covering these points. 

Portland — Geo. B. Swaset, m. d. 

Diphtheria — Nine cases. 

Typhoid Fever — One case. 

I have had twenty cases of the diarrhoeal diseases among children, 
and ten among adults. 

While a gentleman, Mr. C, was in a store in the eastern part of 
the State, a man who had recently lost two children with diphtheria, 
and at the time had others sick with the disease, came into the store 
and made some purchases. Mr. C. was taken sick eight days sub- 
sequenth' with a mild form of diphtheria, not having, to his knowl- 
edge, suffered other exposure to the infection. 

Portland — A. S. Thayer, m. d. 

Diphtheria — Five cases. 
Typhoid Fever — Six cases. 

The diarrho'al diseases have not been especially prevalent. Measles 
and whooping cough have prevailed. 

Portland — A. V. TiiOMrsoN, sr. d. 

Diphtheria — Seven cases. 

Typhoid Fever — Six cases in Portland, two in Cape Elizabeth. 
In ray practice, the diarrhoeal diseases of children have been quite 
prevalent. 

Portland — F. P. Wauren, m. d. 

Diphtheria — Six cases, two of which died from diphtheritic croup. 

Typhoid Fever — One mild case. 

From plitliisis, one death observed. Tlio diarrhaval diseases of 
children have not been very prevalent, according to m^' observation. 

The principal causes have been neglect, milk diet and maternal 
ignorance. 



118 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

During my absence I understand that diphtheria was unusually 
prevalent about the eastern end of the city, and that it has been 
attended with an unusual fatality. At one place where there were 
three fatal cases, the plumbing was defective. The soil pipe was 
disconnected with the sewer, so that the house drainage discharged 
outside of the sewer pipe instead of within it. To lessen the prev- 
alence of these diseases, I would suggest the enforcing of quarantine. 

Princeton — C. Flower, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

One death from phthisis. There have been but very few cases of 
the summer complaint of children. It has been very healthy the 
past year. Rheumatism and the rheumatoid affections have been 
the principal diseases. To lessen their prevalence I would suggest 
the substitution of woolen clothing for cotton. 

For the year September 1, 1885, to September 1, 1886, the mor- 
tality has been as follows : in Princeton from chronic spinal disease 
one death, from leucoeythsemia, one ; in Waite, one death from con- 
sumption ; in Topsfield, one from erysipelas and one from prostatitis. 

Readfield — W. A. "Wright, m. d. 

Diphtheria — Two cases, one ver}' severe. 

Typhoid Fever — None observed. 

Scarlet Fever — One case. Three deaths from phthisis. The di- 
arrlujcal diseases have been very prevalent. The principal causes 
have been drj-ness of the weather and sudden changes from warm to 
cold. For the improvement of the public health I would suggest 
greater cleanliness and the putting on of additional clothing when 
the weather becomes chilly. 

I have seen one case of lead poisoning resulting from handling 
printers' type for several years. This case was very severe, with a 
slow recovery. In animals there have been several cases of poison- 
ing from eating Paris green in the potato fields. 

Richmond — Ahial Libuy, m. d. 

Diphtheria — Three cases. 
Typhoid I'cver — Three cases. 



REPORTS OF MEDICAL CORRESPONDENTS. 119 

Two deaths from phthisis. There have been but very few eases 
of the diarrhd'al diseases. We have had no epidemics and the past 
year has lieen unusually liealtliy. 

Rockland — F. H. Boynton, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

Scarlet Fever — In Rockland, six cases; in South Thomaston, 
seven. Under ni}' observation there have been two deatlis from 
phthisis in Rockland and one in Camden. Tlie diarrhoeal diseases of 
children have been ver^- prevalent. I think the peculiarity of the 
season has been the main cause. I had a large nun)l)er of cases of 
dysentery during the summer, — 86 cases in the months of July and 
August. 

I am satisfied that one case of scarlet fever in a child, of four 
years, was traceable to no other cause than getting into an old gar- 
ret that was used as a general storehouse and tliere tiiuling some 
playthings of children who lived here nearh- twenty years ago, get- 
ting them out and using them all one day,, particularly a woolen 
rabbit which the child's mother told me belonged to a child nearly 
twenty years ago, which had malignant scarlet fever and died in the 
house. I used every means to ascertain if the child had been ex- 
posed, and learned that no cases existed at the time in the village, 
and as the case was most severe in its type of malignancy I was 
especially desirous of tracing its origin if possible. 

Rockland — C. R. Cole, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Twelve cases, three fatal. 

Scarlet Fever — Six cases. Two deaths from phthisis. The diar- 
rha?al diseases of children have been very prevalent. 

In one case scarlet fever was undoubtedly transmitted by the books 
of a teacher, who was herself sick a year previousl}'. 

A faniilv from the country came to this city in August, 1885, and 
took up their abode in a locality known as ''The Point." Instead 
of using water from the city's water service, they drew their supply 
from an abandoned well. About this well were three privies, all 
within fifteen feet of it. Oct. 2d, a child of eight years was taken 
with typhoid fever. Soon after, the remainder of the family, consist- 



120 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

ing of the parents and five children, fell ill with the same disease. 
The mother died the second day after taking her bed ; one child ou 
the twenty-second daj', and another on the twentj-fourth day of the 
fever. All the rest recovered after a long and severe illness. 

Rockport — H. B. Eaton, m. d. 

Diphtheria — Nine cases. 
Typhoid Fever — Eleven cases. 

One death from phthisis. The diarrhoeal diseases of children have 
been very prevalent. Improper diet has been the principal cause. 
The sanitary condition of our locality is bad. 

Saccarajjjm — C. W. Bailey, m. d. 

Diphtheria — Four cases. 

Typhoid Fever — Two cases now on hand, and know of five other 
x;ases in town at the present time. 

Scarlet Fever — Five cases. The diarrhtoal diseases of children 
have been very prevalent. Tliese cases have been principally among 
the French population, and insanitary conditions, with overcrowding 
of families, seemed to enter largely into the causation. Much is 
needed to improve the sanitary condition of this village. Some of 
the things that need to be remedied are insufficient drainage, bad 
arrangements of water closets and privies. We have a water supply 
drawn from the river directly above the village, and but a few miles 
farther up there are large manufactories where all the wastes and 
excreta are dropped into the river, and still farther up a large pow- 
der manufactory with all its accompaniments of acids, salti)etre, 
soda and soot. It seems to me that this must render the water 
unfit for cooking purposes. One case of scarlet fever was contracted 
in school from a child which had had this disease four weeks pre- 
viously. 

Saccarappa — T. P. Smith, m. d. 

Diphtheria — One case. 

Tyiilioitl Fever — Seven cases. 

Scarlet Fever — One case. Two deatlis from phthisis. The diar- 
rha-al diseases of children have l)een very prevalent. The most 
frc'fpKMit causes have l)een failure of the child to receive proper food 
at proi^er intervals, and unsanitary condition of dwellings. Very 



REPORTS OF MEDICAL CORRESPONDENTS. 121 

much might be done to improve the sanitary condition of this village, 
in fact, much is being done in the way of caring for sewage. The 
soil being clayey necessitates much care in draining house lots, but 
this is not very general!}' attended to. Sewers are being laid every 
year as fast as moue^' can be raised. 

Saco — R. S. Graves, m. d. 

Diphtheria — No eases observed. 
Typhoid Fever — None observed. 

Measles have been spread in the schools by permitting scholars to 
attend after the disease had made its appearance. 

Saco — S. P. Graves, m. d. 

Diphtheria — Five cases. 

Typhoid Fever — Two cases. 

From phtiiisis. two deaths have been observed. There have been 
fewer cases of the diarrhceal diseases than usual. Injudicious feed- 
ing is the greatest cause. Measles have been more general than for 
several former years ; whooping cough has been the next most prev- 
alent disease. Most of the cases were among school children, and 
I would suggest more care not to send children to school when 
infected with these diseases. To improve the sanitar\' condition of 
this city, I would suggest emphatically, sewerage. Instead of col- 
lecting sewage and turning it out upon the surface in the very centre 
of the cit}-, conduct it to the water b}' a very short, feasible plan. 

There have been about fifteen or eighteen cases of hog cholera. 

One fatal case of typhoid in a child appeared to have originated 
from the child's playing in the drainage from the sink spout after it 
had passed four or five rods under ground. 

Saco — n. V^. Hill, m. d. 

Diphtheria — Six cases. 

Typhoid Fever — Six or seven cases. 

Scarlet Fever — Three cases. Three deaths from phthisis. Diar- 
rha?al diseases have not been very prevalent. Improper feeding is 
the principal cause. 

"Can you suggest any method of improving the sanitarj' condition 
of your locality ?" Yes; fill up every well in the city and abolish 
privy vaults and build sewers. 



122 STATE BOAED OF HEALTH SECRETARY'S REPORT. 



Saco — F. E. Maxcy, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Six cases. 

One death observed from phthisis. There have been many cases 
of the diarrhccal diseases, caused principally bv overfeeding and 
sudden cold. For improving our sanitary conditiou we need very 
much a s^-stem of drainage. 

Searsmont — G. E. McCurdy, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Two cases. 

Two deaths have resulted from phthisis. The diurrhd'al diseases 
of children have not been very prevalent. Impure water is a com- 
mon cause. 

Better school-houses, with better ventilation of them, would be a 
sanitary improvement. 

Shapleigh — F. A. Bragdon, m. d. 

Diphtheria — Three cases. 

Typhoid Fever — Two cases. 

There have been many cases of the summer complaint of children ; 
the principal causes, improper food and sudden weather changes. 
Whooping cough has been quite prevalent. 

Sherman — D. H. Owen, m. d. 

Diphtheria — No cases observed since October, 1885. 

Typhoid Fever — None observed. 

Tlie diarrha*al diseases of children have been very prevalent, with 
two deatiis in August and one ia September. Under my observa- 
tion the disease has been frequently caused by improper diet. 

South Benvick — C. P. Gerrisii, m. d. 

Diphtheria — Fourteen cases, with two deaths. 

Typhoid Fever — Three cases. 

One death from phthisis. Tiic diarrha-al diseases of cliildrcn have 
been quite prevalent. The most coinmou causes are the filthy sur- 
roundings. 



REPORTS OF MEDICAL CORRESPONDENTS. 



123 



Diphtheria has not prevailed here as an epidemic, as was reported, 
but we have had several sporadic cases, due, apparently, to insanitary 
conditions. For instance, at a point near the river in the southern 
part of the village two boys, each in separate families, were attacked 
at the same time. One case was mild in form, the other, in a nine- 
years-old, thin, pale, and poorly-nourished boy, was severe and com- 
plicated. He first complained of sore throat for several days and 
then when I first saw him I found a dirt}', white exudation covering 
the tonsils and throat generally. At the same time he was very 
hoarse. After ten days the throat cleared, but croupal symptoms 
came on and the cervical glands became swollen and a profuse diar- 
rhoea was wasting the little patient until it was checked. Then the 
nasal passages became involved and in forty-eight hours the nostrils 
were completely plugged. At the end of three weeks rheumatoid 
pains required the continued use of morphine for four or five days. 
During the fourth and fifth weeks there were typhoid symptoms with 
rose spots and sudamina, flatulence, the characteristic pea soup dis- 
charges and delirium at night. By meeting the many complications 
as they arose and keeping up the nutrition of the patient as well as 
possible he lived for five weeks. 

The sanitary conditions surrounding this case were as follows, 
and the accompanying diagram will help to explain them. 



N. 



<\ 





Struct 













1 




4 


D Privy. 

— Sink Spout. 

O Well. 
— Sink Spout. 



The house No. 1 had but two rooms below and two attics above, 
with a shallow, wet cellar. Within twenty-five feet of the house on 
the south there was a privy used by four families, with a small vault 
overflowing at every rain. Twenty-five or thirty feet south of the 
privy, situated between two sink spouts, each of which was not more 
than ten feet from it, was the well. The well is twelve feet deep, 



124 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

and the bottom is a ledge, and the ledge was dug into about one 
foot when a water vein was found and then, with bricks and cement, 
the well was built up around this water vein to the top. Therefore, 
it is claimed by the owner that the sui'faee water does not affect the 
well. In house No. 4, there were four cases of tj'phoid fever two 
years ago. 

In another house there were four severe cases. In this house the 
sink had no trap ; the pipe went down into the cellar, and then hor- 
izontally' to the outside of the house, where it discharged on the 
surface of the ground. The house had not been used for a month, 
and about the last of Julj' the mother moved in with her children. 
Thinking that the house was not sweet, she poured a wash boiler of 
hot water into the sink. The result was that the house was filled 
with the fumes and germs, and in one week the first child was at- 
tacked. So in every case the cause appeared to be local. 

Southivest Harbor — H. E. Abbott, m. d. 

Diphtheria — None observed. 

Typhoid Fever — At Southwest Harbor, three cases ; Cranberry 
Isles, one case. 

There have not been many cases of the diarrhoeal diseases among 
children. Sanitary improvements which might be suggested are a 
supply of water from one of the neighboring lakes, and good sew- 
erage. 

Springvale — Ivoky Brooks, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

The diarrhoeal diseases of children have not been very prevalent. 
The principal causes of these diseases are generally teething and 
hot weather. 

St. Albans — C. A. Moulton, m. d. 

Diphtheria — One case in August. 

Typhoid Fever — One case in August. 

Scarlet P^ever — One case in March. Three deatlis from phthisis. 
The diarrhfcal diseases of children have been very prevalent. In 
every case of these diseases the bal)ies have been artificially fed, 
using the nursing bottle with a long rubber tube. According to my 



REPORTS OF MEDICAL CORRESPONDENTS. 125 

observation this has been the more frequent cause, owing to improper 
care of the tubes. 

When I was called to the case of scarlet fever reported above, on 
making a careful enquiry I obtained the following points. In ISIay, 
1881, Mr. L.'s three children were taken with scarlet fever without 
any known exposure. The youngest died. The mother states that 
she washed and aired this child's clothes and put them away in a 
close trunk, and that she has taken them out at least once a year for 
the purpose of airing them. In March, 1886, the oldest bo}' and his 
four-years-old brother were permitted to open this trunk and take 
the clothes out and use it as a box in which to keep their playthings. 
In fourteen daj'S from the first opening of the trunk the four-years- 
old boy began to show symptoms of scarlet fever, which developed 
into a typical case of that disease. The clothes in the trunk con- 
sisted of ordinary cotton clothes, with one pair of woolen stockings. 
There has been no other case of this disease in town. The house is 
situated on the side of a hill above the highway, and no other build- 
ing within a hundred rods. The highway is a cross road and used 
for local travel only. The child had not been awa}' from home or 
exposed in any other known way. Was the trunk the source of the 
contagion ? 

Standish — Wm. B. Cobb, m. d. 

Diphtheria — One case in HoUis. 

Typhoid Fever — None observed. 

Four deaths from phthisis. The diarrhocal diseases of children 
have not been ver}- prevalent. 

There was one case of fever of a decidedly intermittent type, in a 
young lady who returned from Biddeford, where she had been stay- 
ing. She came home quite unwell and in a few da3's the fever de- 
veloped and she was very sick for about six weeks. She was quite 
sure she contracted the disease through the water supply at her 
boarding-house, it being from a well. 

Strong — Alfred Hitchcock, m. d. 

Diphtheria — None observed. 
Typhoid Fever — None observed. 

Three deaths from phthisis. Cases of summer complaint of chil- 
dren have been unusually infrequent. 



126 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

The sanitary condition of Strong and vicinity is exceptionally 
good. Situated in the valle}- of Sandy River, the drainage is all 
that could be desired. Our population are mostly tillers of the soil 
who live in well-kept houses, and cleanliness is the rule. 

Su7nner — C. M. Bisbee, m. d. 

Diphtheria — None observed. 

Typhoid Fever — In Sumner, five cases ; in Paris, three. 

From phthisis, four deaths in Sumner, one in Paris, one in Wood- 
stock. The diarrha?al diseases of children have not been very preva- 
lent. The principal causes have been teething, bad milk and inju- 
dicious nursing. 

Surry — W. E. Emery, m. d. 

Diphtheria — Five cases. 

Typhoid Fever — Three cases. 

One death from phthisis. The diarrhoeal diseases of children have 
been very prevalent. The principal causes have been the dry season, 
impure water and green apples. We were obliged to close the 
schools on account of a limited number of mild cases of diphtheria. 

I was called to see a cliild in East Bluehill last spring, suffering 
from what I supposed at the time to be poisoning from ivory leaves 
and wild parsnips, as I had one case besides presenting nearly the 
same symptoms, but on m}' next visit, looking more closely into the 
matter found them all passing more or less bloody mucus, — two 
women, three little girls and one boy. The child first taken sick 
and seen by myself died from the effect of a poison received, ac- 
cording to my opinion, from impure sanitary surroundings. Last 
spring was very dry. Tiie water they drank was taken from what 
would be called during a wet season, a running brook, but which 
was, at that time, nearly stagnant water. The lady of the house 
kept a great many hens, and had almost as many hen houses, which 
were distributed nearly around the house, filling tlie house and the 
sleeping apartments with their obnoxious odor, which was constantly 
being inhaled by them all. But I can say now that their hygienic 
surroundings are all that could l)e expected. They are all well, and 
think they have learned a good lesson. 



REPORTS OP MEDICAL CORRESPONDENTS. 127 



Swan's Island — A. N. Witham, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Two cases this fall. 

Three deaths from phthisis. There has been no great prevalence 
of the diarrhoeal diseases of children. The principal cause is im- 
proper diet. Of other diseases there has been a prevalence of 
whooping cough and pneumonia. 

For the improvement of the sanitary condition of our localit}', the 
wells should be dug where the drainage of the house and outbuild- 
ings shall not flow or soak directly into them. 

There were several cases of diarrhcea in certain families, due to 
stagnant water in wells when the water was very low. 

Topsham — I. S. Curtis, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case. 

Two deaths from phthisis. There has been a considerable preva- 
lence of the diarrha'al diseases of children, with two deaths. 

A rather light epidemic of measles in the winter and spring. Two 
of our schools were closed three weeks on account of it. It is 
thought that the infection was brought from Bath by a teacher, who 
imparted it to about half her pupils, and it subsequent!}* spread to 
the neighboring school. 

Tremont — J. B. Phillips, m. d. 

Diphtheria — None observed. 
Typhoid Fever — One case. 

The diarrheal diseases of children have been quite prevalent, 
caused principally by the impure water due to the drouth. 

Tremont — Wm. A. Spear, m. d. 

Diphtheria — Seven cases in Tremont ; two in Mount Desert. 

Typhoid Fever — Four cases. 

Scarlet Fever — Six cases in Tremont ; one case in Mount Desert. 

The diarriicral diseases of children have been quite prevalent, but 
the cases have yielded readily to treatment. The principal causes 
have been impure water and bad fruit. 



128 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

In one family where there were three persons susceptible, thej' were 
infected with scarlet fever from rags which were infected more than 
one year before by exposure to the disease and had lain in an un- 
occupied house all that time. 

Troy — M. T. Dodge, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

Four deaths from phthisis. The diarrha^al diseases of children 
have been quite prevalent, caused largely by the hot weather, bad 
water, and green fruits and vegetables. 

The sanitary condition of the town would be much improved by 
more care in the location and protection of the wells, — which are the 
main dependence for the water suppl}', — from drainage from sink 
spouts, privies and yards. 

Turner — J. T. Gushing, m. d. 

Diphtheria — None observed. 
Typhoid Fever — None observed. 

There have not been many cases of the summer complaint of chil- 
dren. 

Turner — Roscoe Smith, m. d. 

Diphtheria — Four cases in Hartford. 

Typhoid Fever — Four cases in Turner, and two in Leeds. 
From phthisis two deaths. The diarrha-al diseases of children 
have been very prevalent, caused mostly by errors in diet. 

Unity — Austin Thomas, m. d. 

Diphtheria — Three cases in Burnham. 

Typhoid Fever — None observed. 

One death in Troy from phthisis. The few cases of diarrhoeal 
diseases among children have mostly been caused by a ))ad dietary. 

The cases of diphtheria reported above were all in one family 
and the disease undoubtedly came from a visitor from Massachu- 
setts who had had diphtheria some weeks before. 

Some years ago I had a case of malignant scarlet fever which 
terminated fatally within forty-eight hours. There had l)ccn no 
other cases in the vicinity for a long time and the only way it could 



REPORTS OF MEDICAL CORRESPONDENTS. 129 

be accounted for was the reception of a letter from frientls where 
they were having scarlet fever. This was an isolated case, no other 
cases occurring. 

Van Bur en — J. C. Upham, m. d. 

Diphtheria — Two cases, one fatal. 

Typhoid fever — Twent3--seven cases, three fatal. 

Two deaths from phthisis. There have been many cases of the 
diarrhoeal diseases among children, caused mostly by improper feed- 
ing. We have had an epidemic of typhoid fever and new cases are 
still occurring. Proper drainage and new water supply may pre- 
vent the disease in the future. 

Vanceboro — Wm. Beattt, m. d. 

Diphtheria — Two cases. 
Typhoid Fever — None observed. 

There have been but few cases of summer complaint among chil- 
dren, and no deaths. 

Vanceboro — M. L. Young, m. d. 

Diphtheria — Nine cases, two fatal. 

Typhoid Fever — Two cases. 

Scarlet Fever — One case. Two deaths from phthisis. The 
diarrha?al diseases of children have been verj' prevalent. According 
to my observation the causes have been : I. Excessive heat with 
the atmosphere heavily charged with watery vapor at the same time. 
II. Improper food. III. During September, I traced many cases 
directly to the water supply. During September there was a great 
excessoverotheryearsof cases of choleric diarrhwa of adults, largely 
due, I believe, to the dr}' season and its consequent effect upon the 
water suppl}-. 

In the family of Mr. A., three years ago, there was diphtheria. 
Little attention was given to disinfection, but there were no other 
cases in the village. Some of the clothing used upon the patients 
was, after washing, cut up for mat-rags and laid away. The follow- 
ing spring, during the home-cleaning season, these rags were over- 
hauled. The result was another outbreak of diphtheria, and the 

9 



130 STATE BOARD OF HEALTH — SECRETARY'S REPORT. 

transmission of the disease to a second family, who were supplied by 
Mr. A. with milk. There was no other prol)able cause of infection. 
A few months afterward Mr. A. removed to another house in which 
there had never been an^' cases of this disease. This, of course, 
necessitated another stirring up of these mat-rags, and another case 
of diphtheria was the result of it. I depend upon family history for 
the early part of this. The last two attacks I liave personal knowl- 
edge of. 

Vinalhaven — G. W. Phillips, m. i>. 

Diphtheria — None observed. 

TN'phoid Fever — One case iu North Haven now under treatment. 

Four deaths from phthisis in Vinalhaven, one iu North Haven. 
There has been an average number of cases of the diarrha^al dis- 
eases of children. 

There have been no other diseases especially [prevalent excepting 
tonsilitis and inflammations of the lymphatics, of which there were 
seven cases in one family and as many more among the neighbors 
who were using the same water. 

Vinalhaven — F A. Smith, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

There has been a considerable number of cases of the diarrha'al 
diseases in children, apparently caused by the drouth and poor 
water. 

Waldo — A. C. Kllingwood, m. d. 

Diphtheria — Seven cases in Belfast ; one in AValdo. 

Typhoid Fever — One case in Belfast, two in Waldo, and one in 
Swanvilie. 

One death from phthisis. The diarrlueal diseases of children have 
been very prevalent, caused i)rincipally by the heat and the drouth and 
by sudden transitions from heat to cold. The sanitary condition of 
this locality would be improved l)y better drainage and a water sup- 
ply for the city proper. 

Walduboro' — F. M. Eveleth, m. d. 

Di[)htheria — None observed. 

Typhoid Fever — Two cases in Waldoboro' and three in Bremen. 



REPORTS OF MEDICAL COKRf:SPONDENTS. 131 

Scarlet Fever — Three cases. One death from phthisis in Friend- 
ship and two in Gushing. The diarrha-al diseases of children have 
not heen very prevalent. Imprudence in eating has been the most 
common cause. Measles and whooping cough have heen quite prev- 
alent, and in some instances have necessitated the closing of school. 

Warren — J. M. Wakefield, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Eight cases. 

Four deaths from phthisis. There have been many cases of sum- 
mer complaint among children, caused mostly by impure water. The 
most prevalent diseases have been continued fever and typhoid, due 
to bad drainage and poor water. A better supply of water, and 
more care of sink drains and privy vaults would be a sanitary im- 
provement. 

Waterville — S. H. Holmes, m. d. 

Diphtheria — Five cases, two fatal. 

Typhoid Fever — Two cases. 

Cases of the diarrhd'al diseases of children have been frequent. 
There is quite a large French population, and with them the well is 
often within twenty feet of hog-pens and cow-stalls, thus assuring 
the pollution of the water. 1 think this the cause of a large preva- 
lence of summer complaint. 

One case of chronic lead poisoning occurred, and a chemical analysis 
of the water used showed that there was quite a large quantity of 
lead in it 

Waterville — M. II. Holmes, m. d. 

Diphtheria — None reported. 

Typhoid Fever — Two cases. The diarrh<cal diseases of children 
have quite largely prevailed, being caused mostly by improper food 
and unsanitary conditions. The sanitary condition of the town 
would be improved by systems of sewerage and drainage, and a i)urer 
■water supply. 

Wayne — A. L. French, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Three cases in Leeds. 



132 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

Scarlet Fever — One case in Wayne and one in Leeds. The diar- 
rhceal diseases of children have been quite prevalent. 

In the past three years I have not seen a case of typhoid in 
Wayne, and have heard of but one. Of diphtheria there have been 
no cases ; scarlet fever, one case. 

Wells— J. W. Gordon, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Two cases in Wells ; one in York. 

Scarlet Fever — Four cases in York. There have been four deaths 
from phthisis in Wells. The diarrheal diseases of children have been 
very prevalent : there have been two deaths in Wells. The sanitary 
condition of our locality is quite good. 

Woodford's — C. W. Foster, m. v>. 

Diphtheria — None observed. 

Typhoid Fever — Three cases in Deering. 

Three deaths from phthisis in Deering ; one in Westbrook. There 
have not been many cases of "summer complaint." Sewerage would 
be a sanitary improvement. 

Woodstock — C. B. Rankin, m. i>. 

Diphtheria — Five cases in Milton PI. 

Typhoid Fever — One case in Milton PI. ; four in Greenwood. 

One death from phthisis. There has been about the usual number 
of cases of the diarrha^al diseases, mostl}' the result of improper 
food and exposure. 

Winterport — C. F. Atwood, m. d. 

Diphtheria — None observed 

Typhoid Fever — Two cases in Bucksport. 

The diarrhfjcal diseases of children have been very prevalent. 
The cause has been preeminently bottle feeding. Tiie sanitary 
conditions would be improved l)y the ventilation of dwellings, and 
some method of disposing of sink and water-closet accumulations 
which now flow into wells prepared for the purpose, or more com- 
monly on the surface of the ground in the vicinity of dwellings. 

Arsenical Poisoning — At 3 A. M. on the 7th of August, 1881, I 
was called to a family consisting of man and wife, their daughter 



REPORTS OF MEDICAL CORRESPONDENTS. 133 

and her husband and two children, aged respectively 67, 63, 38, 41, 
5 and 2 years. All had been taken suddenly and violently ill at 12 
o'clock, midnight, except the younger man, who became ill one hour 
later. They were all vomiting freel^', had excruciating pain at pit of 
stomach, and all had profuse diarrha-a. The symptoms were of arsen- 
ical poisoning, but close questioning and an examination of the piece 
of potatoes, location of the well, and kinds of food elicited nothing. 
When asked when they ate supper, the reply was, ''At six o'clock, ex- 
cept the younger man, who was away and ate at seven o'clock." I 
then felt certain they had been poisoned by arsenic in the food partaken 
at supper. When I asked what they did with the boxes in which they 
bought the Paris green they applied to the potatoes, they said thcN* 
burned them, and when asked when they burned, thej- said they burned 
them that night at supper time. The meal consisted of corn-meal 
pudding and milk. While making the pudding, the older lady, who 
made it, said she frequently raised the kettle, and while holding it 
in one hand, stirred the fire with the poker, in the other. She said 
she stirred the fire frequently, and noticed that the boxes burned 
ver3' slowly. She was much the sickest of the family. I treated 
them in the bt'licf that they were all poisoned by arsenic, and they 
all recovered. I certainl}- believe, and the family and neighbors are 
of the same opinion, that they were poisoned by the arsenic from the 
boxes, introduced into the pudding during the process of making. 

Cholera Infantum — Almost my first question on seeing a child suf- 
fering from cholera infantum is, — "Is this child bottle fed?" and the 
answer is usually what I have already assumed to be the case, "Yes." 

During the summer of 1882, I was called late one evening to see 
one of a pair of twin boys about four months old. Found iiim emaci- 
ated to an extreme degree, unconscious and moribund. His brother 
was in the cradle, fat and in excellent health. On inquiry I found 
he had been sick but twelve hours, though to judge from appearances 
I should have said he had been sick a week. On ray next visit, 
twelve hours afterward, I found him dead and his brother looking as 
bad as he had the night before. Under proper diet aud treatment he 
lived five days, but without any perceptible improvement. I had 
previously examined the cow from which the child received its milk 
and found all the usual requirements fulfilled ; but I had coucluded 
something more must be done or the child would die. On careful 
enquiry I found that the water in the pasture was good and al)undant, 
but the grass was closely fed by the large herd in the pasture. Owing 



134 STATE BOARD OF HEALTH SECRETARY'S REPORT. 

to drought, feed was short, and the father thought the cows might be 
obliged to eat other than fine grass. At my earnest request this cow- 
was put in a field of clover, alone, and watered three times dailj 
from a fine well. Next day the child began to improve, and in four 
days more I dismissed the case, so far convalescent as not to further 
need m}* services. 

This year I had very man}' cases of the disease and complained 
after some time of the milk. The milkman, who supplied five of my 
cases, having heard of my complaints, asked me what better he could 
do in order to provide proper milk. I advised him to tie the "-baby" 
cow in a clover field and water her from a spring, which he did, and 
every case was off m}- hands in less than a week, and not one has 
again required my attention, though children using milk from other 
cows have been repeatedly sick since. These cases, as all others,. 
are of course put under the best possible conditions aside from the 
milk, such as daily baths, rides, warm clothing, well-veutilated 
rooms, and clean tubes and bottles. 

Winterport — A. R. Fellows, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Three cases. 

Tvvo deaths from phthisis in AYinterport and one in Prospect. The 
diarrhoeal diseases were quite prevalent during August, due largely 
to bad milk and food. 

Winthrop — Danip:l Driscoll, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case. 

One death from phthisis. The diarrheal diseases have been moder- 
ately prevalent, most of the cases having been among the Canadia» 
population from eating unripe fruit and from bad sanitary surround- 
ings. 

Among swine, hog cholera prevailed to some extent. In one in- 
stance twenty-eight out of thirty-four cases were fatal, and in another 
instance there was nearly as great a mortality. 

Winthrop — A. P. Snow, m. d. 

Diphtheria — None observed. 

Typhoid Fever — One case only and that imported from Augusta, 



REPORTS OF MEDICAL CORRESPONDENTS. 135 

There has not been a great prevalence of the diarrha'al diseases 
of children. Two deaths from this cause resulted in the French popu- 
lation, where there was a want of cleanliness about the premises. 
The general sanitary' condition of this town is good. 

Wiscasset — C. A. Peaslee, m. d. 

Diphtheria — Three cases. 

Typhoid Fever — None observed. 

Scarlet Fever — One case. Five deaths from phthisis. Three 
deaths have resulted from the diarrha-al diseases of children, and 
there has been quite a prevalence of these diseases resulting frona bad 
air and improper feeding. 

I think the case of diphtheria arose from causes wholly within the 
immediate surroundings of the patients, overflowing privies being 
found where both fatal cases occurred. Our village, as in all villages 
of its class, is noted for its accumulative privies and foul sink drains, 
both frequently being in close proximity to wells. Anything which 
would change this condition of things would greatly improve the health 
conditions of the people. 

Yarmouth — J. C Gannett, m. d. 

Diphtheria — None observed. 
Typhoid Fever — None observed. 

Scarlet P>ver — One case. There has been a very great prevalence 
of the diarrluL'al diseases. 

Yarmouth — Wm. Osgood, m. d. 

Diphtheria — None observed. 

Typhoid Fever — Two cases. 

Scarlet Fever — One case. The diarrheal diseases have been quite 
prevalent, but more so among adults than among children. 

The only case of scarlet fever seen during the year was in a child 
about eight months old. This child had been dressed in clothing 
which had been worn by another child during an attack of scarlet 
fever eighteen months before. I know that the clothing was not dis- 
infected after the sickness. In about ten or twelve days from the 
date of putting on the clothing, the infant was attacked with the 
fever. 



136 STATE BOARD OF HEALTH SECRETARY'S REPORT. 



Yartnouth — "W. W. Thomas, m. d. 

Diphtheria — Two cases. 

Typhoid Fever — Five cases. 

There has been a considerable prevalence of the diarrhoeal dis- 
eases, but they have generally been of a mild type. The principal 
causes have been changes in diet, improper food, and high tempera- 
ture and sudden changes. There is often a general mismanagement, 
and the disease is sometimes caused 1)}' the lack of warm clothing 
for the abdomen. 

There has been a greater prevalence of typhoid fever than I have 
ever known here in one year. I think much might be done in the 
prevention of this disease by the proper care of the first cases as 
regards the discharges from the bowels. 

The sanitary condition of the place would be improved by discon- 
tinuing the use of water from all the old wells in the village. 

York — John C. Stewart, m. d. 

Diphtheria — None observed. 

Typhoid Fever — None observed. 

One death from phthisis. The diarrhoeal diseases of children have 
not been very prevalent. Whooping cough has prevailed to a limited 
extent. 



Various Sanitary Topics. 



BY THE SECRETART. 



THE CONTAGIOUSNESS OF CONSUMPTION. 

Before the publication of the First Annual Report a series of ques- 
ftions was sent out to the physicians of the State, relating to various 
subjects which are of sanitary interest. Among them was one as to 
'the contagiousness of pulmonary consumption, which read as fol- 
Jows : ''Please communicate any observations which seem to show 
the infectiousness of phthisis." 

To this circular letter of enquiry, there were received answers from 
170 phiisicians. Of these 170 physicians, 91 made no answers to 
•this particular question, and 79 answered it. Of those answering 
•the question, 23 replies indicated that no observations had been made 
which would show the infectiousness of the disease, and of these, 
four stated definiteh- that tliey did not believe in the infectiousness 
of the disease. On the other hand, 51 answers indicated either a 
belief in the contagiousness of the disease or that observations had 
been made which would seem to show its infectiousness, and of these 
25 mentioned or narrated cases which were thought to show this. 
Be.side these 51 answers, there were 3 others which probably should 
be classed with these as favoring the idea of contagion, but are not 
,put with them on account of a little doubt as regards the meaning 
which the writers intended to convej'. 

Tabulating the replies which were received, we have the following 

results : 

Negative observers, 23 

Adirmative observers. 51 * 

Doubtful answers, 3 

A few years ago a similar enquir}* was made under the auspices of 
the British Medical Association, and in answer to the enquiry sent 

(137) 



138 STATE BOARD OF HEALTH SPECIAL PAPERS. 

out 1078 returns to their circular were received Of these returns- 
673 were simply negative, showing that no case had been observed 
b}' the member making the return, but expressing no opinion. Such 
returns were set aside, as admitting of no further anal^-sis The re- 
maining answers, containing observations of some kind, were classi- 
fied as follows : 

Class 1. Affirmative observers, 261 
Class 2. Doubtful observers, 39 
Class 3. Negative observers, 105* 

The result of the enquiry, both in this State and in England, shows- 
that a majority of the medical practitioners making answers believe 
in the infectiousness of pulmonary consumption, and that a largfr 
number have been led to this belief through their own personal ob- 
servations. This enquir}', if it had been made a decade ago, probal)ly. 
would have given somewhat different results. 

It was not many years ago when, in the prevailing teaching of 
those days, one would have heard but very rarely an}' words which 
would have indicated any decided conviction that contagion or infec- 
tion played any part in the etiology of the disease. In the light of 
history, tliis change in the prevailing medical opinion as*i-egards 
consumption must be regarded as a reversion to an earlier phase of 
medical thought. About one huiulred years ago the prevailing opin- 
ion among the medical profession in the south of Europe was strongly 
in favor of the infectiousness of consum[)tion, and this belief shaped 
the sanitary treatment of the unfortunates who were afflicted with 
this malady. Dr. J. Uffelmann-f relates, as the result of his inves- 
tigations into the medical history of this sul)ject, that in the year 1782,. 
just one century before the discovery of tlie bacillus tuberculosis by 
Koch, that the central sanitary bureau of Naples expressed the 
opinion that tuberculosis should be regarded as infective, and in 
accordance with these views, rules and regulations were promulgated 
to guard against the cominuiiicution of the disease. The decree 
which they issued in that year i)rovided, among other things, that 
every practising physician should give immediate notice to the l)ureau 
of the appearance of consunq)tion in any of his patients, under pen- 
alty of a fine of three hinidred ducats, and for a second otfense, of 
an exile of ten years from his M:iliv(! country ; for the isolation in. 



*The JloHton Mc(li(!ul and Suixiciil .Joiiniul, V^ol. (-'IX, p. 'J07 
tBcrlincr kliiiisclif! WocliHchrift, Juno 11, 1883. 



VARIOUS SANITARY TOPICS. ISi^ 

hospitals of patients affected with the disease ; that all articles and 
effects of the patient not supposed to have been infected were to be 
thoroughly cleansed, while those which were supposed to be infected 
were to be burned or disinfected in some other manner; that the 
directors were to thoroughly disinfect the rooms or wards which had 
been occupied by the tuberculous patients, and that the doors and 
windows should be removed and burned and replaced by new. These 
harsh measures, which were believed to be necessary for the safety 
of the public health, were rigorous!}' enforced for many years, and 
the decree was in existence, though somewhat less strictly adminis- 
tered, as late as the year 1848. From that time on until near the 
present the belief in the communicability of phthisis had declined in 
that country until but few physicians were found wlio were on the 
side of contagion. 

There is liardly another disease which lias brought out so great an 
amount of earnest work and discussion with the view of arriving at 
the truth as regards its etiological, histological and pathological cliar- 
acteristics as lias pulmonary tuberculosis, or consumption. The 
history of these various researches, though an interesting profes- 
sional study, would be widelv out of place in a volume designed for 
the geiienil reader; therefore, uitliout submitting the various steps 
which have led up to such conchisions, it will be sufficient to say that 
it appears to be definitely determined : 

1st. That the tuberculosis of cattle and other animals is identical 
with the tuberculosis of man. 

2d. That human consumption is a tuberculosi.^ of the lungs. 

3d. Tiiat the disease is characterized by tlie presence of a specific 
contagion, and may be communicated from animal to animal, from 
man to animal, or from animal to man i)v inoculation, hy inlialation. 
or by ingestion. 

As illustrating the fact of contagion, the following cases, mostly 
from (juite recent literature, are given : 

Dr. C. W. Stevens,* of Charlestown, Massachusett.'^. contriliuted 
some years ago the following case : 

Mr R., aged "il*, died of phthisis after three years' sickness. The 
last few montlis of his life he liad a tuberculous diairho'a. His 
expectoration was purulent and profuse. He had returned home 
from abroad oidy six months l)efore his dealli. He was nursed chiefly 
by his young wife, and assisted by his wife's mother. His wife had 

♦Boston Mo.l. iiiul Surg. Jr., Vol. LXXXVI, p. 168. 



140 STATE BOARD OF HEALTH SPECIAL PAPERS. 

a fine constitutiou, a well-developed body, and had alwa3-s been 
healthy. Her mother was likewise a very robust woman of middle 
age, with no hereditary consumptive tendencies. This 3"0ung wife 
was incessant in her devotion to her husband — constantly sitting 
beside him, breathing his breath, bathing his body, and emptying his 
sputa and excretions. Near the end of his life she was taken with 
a slight diarrhoea. After his decease she appeared to go into a decline, 
and died of acute tuberculosis in about six months. About a year 
afterwards her mother likewise died of consumptiou. 

Dr. A. Ollivier,* in connection with the question of the contagious- 
ness of tuberculosis, has given an account of a case which came under 
his observation. A child two years of age, previously' strong and 
vigorous, came to play with another child somewhat older, who died 
of consumption ; the first child rapidl}' withered away and succumbed 
to the same disease. Another child four years old, of good appear- 
ance and with no hereditary predisposition to consumption, entered 
a hospital on account of infantile paralysis. In the bed next to his 
own three children successively died of phthisis ; he played with the 
last occupant, and soon became phthisical like his neighbor. 

A physician in St. Petersburg contributes the following histor}' of 
tuberculous^ infection t A woman, in whose family there was a 
marked history of consumptive tendency, developed symptoms of 
tuberculous infection. There were emaciation, cough, d^'spnrea and 
pulmonary haemorrhage. From 1872 to 1883 she was married three 
times, all three of the husbands presenting at first the appearance of 
health and having no hereditary taint. The first husband, married 
in 1872, died of phthisis in 1879. The second, married in 1879, 
died of phthisis in 188.3 ; he lived with his wife from 1*879 to 1881. 
The third, who lived with her from 1881 to 1883, is at the present 
time in the last stages of phthisis. The woman died of phthisis in 
1883. 

Towards the end of 1884, a prisoner who had rapid consumption 
entered a penitentiar}' composed of eight parallel pavilions exactly 
alike. He was placed at the extremity of one of these pavilions and 
remained there until the 2^th of March, 188.5, coughing and ex- 
pectorating, and without requesting the attendance of a physician. 
At this date he decided to have himself cared for andVas sent to the 
hospital, where it was found that there were numerous cavities at the 

*"Ur.-Tue D'Hyfencuc-," Vol. VII, |). 4:!l. 



VARIOUS SANITARY TOPICS. 141 

summit of the right lung, and whore he died about the second month. 
A little while after his entrance, in the course of April and^May, five 
other prisoners, all in the same end of the pavilion which had been 
occupied by liim, began to cough and successively entered the hos- 
pital on account of pulmonary or pleural tuberculosis. The other 
part of the same pavilion was spared, and during this time the seven 
other pavilions presented nothing special as regards their sanitary 
conditions.* 

In spite of the considerable negative testimony which the non- 
contagionists have been able to adduce, cases like the foregoing have 
been powerful in forcing the conviction that pulmonary consumption 
is an infectious disease. Admitting its infectiousness, as we must 
when aware of the exact experimental methods which have been 
used to establish this fact, there still remains the question, as regards 
the degree of infectiousness, that is, whether its acquisition by in- 
fection is a quite common occurrence or is an exceptional one. An- 
other closely related enquiry is regarding the circumstances and 
conditions under which pulmonary tuberculosis is the most likely to 
be spread by contagion. 

From the nature of the case any statistical or other enquiry to 
settle the question of the degree of infectiousness of this disease 
seems well nigh impossible. On account of the extremely slow 
growth of the bacillus tuberculosis, the exact time when the infec- 
tion occurs is almost always impossible to determine. Unlike the 
other infective diseases, in which their specific micro-organisms are 
of much more rapid growth, and, consequently, in which the period 
of incubation is much briefer, tuberculosis has a period of incubation 
which varies much in length in different cases, but which relativel}' 
is very long. When, therefore, the disease is far enough advanced 
to be recognized clinically, the reception of the infection must be 
referred to a date some months and sometimes some years anterior. 
Adding immensely to the difficulties of enquiries of this kind is the 
fact that the not too distant past has included so many possibilities 
of infection known and unknown. 

The spores of the bacillus tuberculosis, which in the expectoration 
of the consumptive may be ejected dail}- by the million in the 
street, the home, the church or the public conveyance, retain their 
vitality a considerable time, and under conditions which would be 
thought to be destructive of them. Experimentally, Schill and 

♦Revue D'llygiene, Vol. VIII, p. 313. 



142 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

Fisclier* have shown that the sputum may be dried and ground into 
<iust, and in this condition of complete desiccation may still retain 
its infective properties a considerable time. After 95 days, two 
rabbits, and after 126 days, three, were inoculated with this dried 
sputum, and in every case the animals became tuberculous. Experi- 
ments made from this time on showed that gradually the sputum 
lost its infective powers, until in about eight months, when inocu- 
lated into test animals, it proved wholly inoperative. It is the opinion 
of Koch that, in the very great majority of cases, the contagion is 
•carried from the sick to the well by means of the inhalation of this 
dried and finely-powdered sputum. Numerous experiments have 
shown that the inhalation of tuberculous sputum will with absolute 
certainty cau?e animals to become tuberculous, not only those species 
which iiave been shown to be very susceptible to tuberculosis, but 
also those which have greater powers of resistance against this in- 
fection. Man is not supposed to have so great a degree of immnnitv 
as regards this disease as some of these animals have. Indeed, with 
a mortality from consumption of one-seventh of all the deatlis which 
occur from all causes, and with the fact before us that only a minority 
of the cases of phthisis are to be referred to hereditary' influence, 
there are grounds fur a very strong suspicion that the human family 
•have long and unwittingly l)een trying a disastrous inhalation experi- 
ment on themselves. 

In the same line and confirmatory of the German investigations 
and reasonings, the French have been actively awake to the grave 
results which may follow a misapprehension of this question. Be- 
fore the "Academic des Sciences" and the '"Societe de Medicine 
publique," during the past year, several important pa[)ers were read 
on the transmissibility of consumption, and were very fully and earn- 
estly discussed. 

Dr. Alisonf has drawn particular atlention to the succession of 
facts which followed the accidental introduction of phthisis into cer- 
tain, mostly very small, communes, in some of which consumption 
had appeared onh' at rare intervals. In some of the villages studied 
by him, where for thirty years the statistics siiowed not more than 
one death in each year from consumption, after the arrival in the 
community of a person wlio had contracted tuberculosis in a neigh- 
boring city, the disease was spread, became common, and furnished 



*Mittheilun)f(;ii auH ileiji k. (joh., \'o1. II, p. 133. 
tRevuc D'llygiene. Vol. Ill, p. 284. 



VARIOUS SANITARY TOPICS. 143 

thereafter tliree or four deaths a year, usually exchisively in the same 
families, or the same groups of houses. GeneralU- these events 
•occurred as follows : 1st. Tuberculosis was im[)orted into a locality 
hitherto free from the disease. 2d. It was eoinmunicated to other 
persons who had had some lelations with the imported case. 3d. 
The disease developed in little foci or groups, composed generally of 
a certain numl)er of cases related among themselves oi- to the first 
case. 4th. Ordinarily there was no interruption iu the succession 
of cases in the little group or family epidemic, provided the neces- 
sary time were allowed for the transmission, incubation, and ad- 
Tancement of the disease to a jjoint so its pathological significance 
was reco;inizal)le. ^)th. Finally, tuberculosis disappeared completely 
after some length of time ; and in some of the villages, after a con- 
sideral)le period of immunity from the disease, a new importation 
gave rise to a new outbreak. 

As regards the way in which consumption is the most frequently 
communicated, we find a general concurrence with the views of Koch 
and other German investigators. M. Kichard says that phthisis is 
chiefly an inhalation disease, and that primary pulmonary tubercu- 
losis, which is bv far the most common form of tuberculosis by 
infection, is due, almost without exception, to the inspiration of dust 
charged with the bacilli of tuberculosis or their spores. He further 
says that the great source of these bacilli is constituted by the sputum 
of persons affected with [)ulmonary tul)erculosis. 

Dr. Ollivier says, "The most active agent for the transmission of 
tuberculosis resides in the sputum. "Whether ejected to be trodden 
under foot, or accidentally upon the clothing or furnishings, it is 
easily transformed into a dangerous powder." Dr. Martin of the 
"■Comite consultatil d'hygiene de France" gives a similar opinion. 

As regards the prevention of consumption, in view of its contagious 
nature, there should be certain precautions and restrictions observed. 
Hardly any one now advances the opinion that the unfortunate who 
becomes attainted with this disease should be imm\ired within a special 
hospital, or be denied the comfort of his home, if he has one, and 
the solace of his friends ; but, with the fact now well known that the 
infection of the disease is liberated largely and almost wholly in the 
sputa of the sick, regard for the welfare of others urgently demands 
that the infected sputum be rendered harmless. Furthermore, it is 
to be borne in mind that the sputum which soils a handkerchief or 

Revue D'Hygiene, Vol. VIII, p. 30.5. 
Ibid., p. 284. 



144 STATE BOARD OF HEALTH SPECIAL PAPERS. 

other fabrics is easily* reduced into a dangerous powder in the further 
use of these articles, and, therefore, care should be observed that the 
spittoon receives all the expectoration, and that this be effectuall}' 
disinfected. 

The most trustworthy knowledge which we have regarding the 
behaviour of the bacillus tuberculosis when subjected to the action of 
disinfecting agents comes from the experiments of Schill and Fischer.* 
They show that the parasite may be destroyed surely by : 

1. Subjection to the action of steam at a temperature of 212 F., 
for a period of from 30 to 60 minutes. 

2. Immersion in boiling water for 20 or 30 minutes. 

3. Immersion in a 5 or ten per cent solution of carbolic acid for as 
long as twenty-four hours. The quantity of the solution used must 
equal that of the sputum to be disinfected. 

According to their testimon}' the corrosive sublimate solution, so- 
effective for most other disinfecting purposes, is not suited to the 
disinfection of tuberculous sputum on account of its coagulating, 
action. 

SANITARY SIGNIFICANCE OF MILD CASES OF THE 
INFECTIOUS DISEASES. 

Though mild cases of the infectious diseases may bring no serious 
danger to the individual who is the subject of them, it should not 
be thought that their presence is a matter of no concern for those 
whose desire it is to see the preventable mortality of our State dimin- 
ished as much as possible. In these light forms the movement of 
the disease is frequently not evidenced by any marked symptoms, 
and it is exactl}' for this reason that, as regards the community, the 
very mildest forms of a disease may be the most dangerous ; for^ 
though those symptoms on which we are dependent to enable us to 
recognize the nature of the disease may be so far absent as to make 
a certain diagnosis difficult and sometimes impossible, the patho- 
genic agent has been multi[)lying itself within the S3'stem, and is 
ready to exhibit the same infective qualities as though its genesia 
had been in a more malignant case. 

Again and again during the comparatively short time covered by 
the work of this Board, cases have come under its observation in 
which those unrecognized or doubtful cases have given rise to seri- 
ous and fatal extensions of the infectious diseases. 

*Mitthcilungen a. d. kaiicrl. GeBundbeitsamte, Vol. II, p. 139-146. 



VARIOUS SANITARY TOPICS. 145 

Some of these outbreaks must be classed with the "unavoidable 
accidents," but a large part of them, it is believed, might be avoided 
by greater care in coming to the conclusion that a given case is not 
a dangerous contagious disease. A large part of the mischief comes 
from the default of duty on the part of the general public in not 
appreciating the fact, and shaping their actions in accordance with 
it, that contagion is dangerous, and whether generated in mild or 
severe forms of disease, is to be, as far as possible, restricted and 
destroyed. Ver}' often, in spite of the warning of the physician, the 
general public will refuse to be convinced and to take the proper 
precautions due to the disease indicated, because they do not per- 
ceive the same symptoms and appearances which they have been 
accustomed to see in the more severe cases of the same disease. At 
the same time, while we lay this to the charge of the general public, 
we must admit that, with some members of the medical profession, 
there is a tendency, which from a sanitary point of view is a danger- 
ous one, reluctantly and often deferrcdly to give these light, cases 
their true diagnostic names. There is therebj' often done a manifest 
wrong to the public, and one which is recognized sometimes by this 
same public when it is too late. For these members of the profes- 
sion, 1 claim that their action comes in most cases from honorable 
motives. In the first place, it comes from a desire for exactitude in 
diagnosis and the wish not to unnecessarily alarm the public by mak- 
ing a diagnosis of a dangerous disease, when there is a possibility' 
that such a judgment maj- be in error on account of the want of 
well-marked symptoms. It must be remembered, however, that the 
demands of exact pathological science and sanitation must be some- 
times somewhat at variance. While the former demands abundant 
time to make an exact diagnosis, the demands of the public health 
are that every suspicious case shall be regarded and treated as 
dangerous, until the contrary is proved. Let, then, the plea for the 
compaon safety' be heard, and let the public always have the benefit 
of the doubt. Again, physicians are sometimes influenced by their 
desire not to do as some unprincipled charlatans do, who give every 
disease whieh comes under their care a dangerous name, and thus 
seek to make capital out of the fears of the people. 

The di!<astrous results of unrecognized and uncared-for mild cases 
of the contagious diseases are seen very often in diphtheria. The 
English medical health officers have quite frequently had to refer the 

10 



146 STATE BOARD OF HEALTH SPECIAL PAPERS. 

origin of outbreaks of diphtheria to cases which were supposed to 
have been nothing more than simple sore throat. For instance, in 
1884, Dr. Bhixhall made report to the Local Government Board re- 
garding an epidemic of diphtheria at Ashford Hill, which appeared 
to have been due to a sore throat of the teacher. It seems that the 
teacher was taken ill about the 22d of June. On the 23d, she drove 
into Newbury to consult a medical man, who asked her whether 
there was any sore throat in her neighborhood. She remained at 
home two days, and resumed her duties at the school on the 26th. 
'^Evidcnth' this was not a common sore throat, for it rendered her 
incapable of reading to her class, some of the elder children being 
• employed to read for her: she suffered somewhat from i-egui'gitation 
■ of fluids when attempting to swallow, and her vision was affected, 
thus justifying the conclusion that this was a case of diphtheria. 
The entry in the school log on the 4th of July further records: 
'Considerable number of children absent with mumps and sore 
throat.' On the 5th of July, Mr. Maples was summoned to five 
■jother families, all of which he found invaded with diphtheria. The 
.sufferers were pupils of the Ashford Hill school, and to this channel 
most of the mothers ascribed the origin of the disease." 

Seventeen families were invaded and it is noteworthy that of llf- 
:teen out of the seventeen primary attacks, the sufferers were in at- 
tendance upon the school. 

Referring only to the principal outbreaks of diphtheria which have 
•occurred in our own State the past 3'ear, we shall find that the most 
of them have apparently sprung from mild or doubtful cases. In 
Bar Harbor the first case was a mild, unrecognized case, which was 
unreported. The second case, which came from the first b}^ contagion, 
though called diphtheria by one physician, was followed by a public 
funeral and all its unfortunate results. Tlie little one from Allen's 
Corner who died in Boston was reported to have died of diphtheritic 
croup. In Canton, on account of the rash which accompanied the 
cases in the first family, many of the general public would not be- 
lieve that diphtheria was present. In East Madison diphtheritic 
sore throat was prevalent before any malignant cases occurred. In 
some other places not here rei)orted in detail unquestionable diph- 
theria resulted from questionable cases. 

As there are slight cases of all the other forms of disease, so there 
are of diphtlieria cases which fail to put on any marked or char- 
acteristic symptoms. Observations which are sometimes made 



VARIOUS SANITARY TOPICS. . 147 

would seem to show that cases of sore throat in which no trace of 
diphtheritic false membrane is discoverable may, nevertheless, give 
rise to true diphtheria. 80 lax a diagnosis as calling these diphtheria 
is not at all justifiable, but when these cases show an epidemic or 
endemic tendency, especially if accompanied with cases of diph- 
theria, they should be regarded with suspicion. One step farther 
on this debatable ground, we have cases which present "white 
patches" on the tonsil or other parts of the throat. For the non- 
professional reader it is necessary to say that dii)iitheria is character- 
ized by the presence in the throat of a false membrane which, first 
at least, is of a white or whitish color. It may be discovered in its 
incipient stage as quite small patches which may rapidl}' or slowly 
enlarge and coalesce until an extensive formation of the false mem- 
brane results, with usuall}^ severe general symptoms. On the other 
hand, with an almost entire absence, it may be, of general symptoms, 
in mild cases the first discovered small patches ma}' slowh* or more 
rapidly disappear. It is as regards these latter cases that the ele- 
ment of doubt often comes in. 

It is the belief of the writer that almost all these cases of "diph- 
theritic sore throat" are mild cases of true diphtheria, and as such 
are dangerous to the public. In the interest of public health these 
cases, as long as there exists any doubt as to their nature, should be 
regarded as diphtheria. 

They may be confounded with simple inflammation of the throat 
in which there are muco-purulent streaks or patches. If a simple 
ocular inspection does not show that these are loose and easily re- 
movable, a touch with any object will prove that they lack the firm- 
ness and close connection with the underlying tissues which is char- 
acteristic of diphtheritic false membrane. Or these mild cases of 
diphtheria maj* be confounded with follicular tonsillitis. In the 
latter there may l)e seen issuing from the depths of the follicles or 
crypts of the tonsil gray or whitish spots, drops or little accumula- 
tions of secretion, sometimes of a cheesy consistenc}', sometimes 
semi-fluid. If it exudes from the follicles and by its weight sinks 
downward, it ma}- be seen by touching or lifting it with a probe that 
its origin is from the natural openings of the crypts of the tonsils. 
It also lacks entirely tlie characteristics of the superficial but some- 
what firmly adherent diphtheritic false membrane. Finally, there 
rarely occuris a herpetic pharynyitis, which may be left ofltof account 
for its rarity. 



148 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

The diagnosis of diphtheria should ahnost alwa^'S be a very easy 
matter ; l)ut cases do occur in which a prompt and positive decision 
on the part of the physician cannot conscientiously be made. The 
practitioner must then claim a little delay, and at the same time give 
a caution against possible contagiousness. This is due to the public. 
From the public is due a little charity to the physician now and then 
for a diagnosis with an interrogation mark put in for the safety of 
the community. The mistake of calling a non-infectious sore throat 
diphtheria, or calling chicken-pox small-pox, ma}* cause temporary 
inconvenience to a few individuals, but the converse error may need- 
lessl}' fill a dozen graves. 

COMPAEATIVE VALUE OF XEGATRT: EVIDENCE AS TO THE 
NON-CONTAGIOUSNESS OF DISEASES. 

Physicians and others in cautioning the public against the danger 
of the spreading of certain diseases, regarding whose infectious na- 
ture there should be at the present day no question in the minds of 
common, intelligent people, are nevertheless met and opposed quite 
frequently' in their humane work by those who show the spirit of 
Thomas, the doubtful. It is not wrong to demand of him who 
teaches dogmatically, to show the proofs of the truth of that which 
he teaches ; but when, as regards those diseases the infectiousness 
of which is attested by a long line of positive facts extending over 
many years, some person opposes to it all a single observation or a 
few observations of his own, which he tells you disprove the conta- 
giousness of the disease, it is time to call his attention to the value 
of such negative observations as his, as compared with the value of 
such positive testimon}- as may exist bearing upon the same question. 

For instance, there came to the knowledge of the writer the two 
following histories of scarlet fever. 1st. At a time when there were 
no other cases of the disease to account for this one, a child in a 
family of three children, of susceptible ages and unprotected by pre- 
vious attacks, had scarlet fever and died. The other two, though in 
the same house, and sometimes in the same room, did not take the 
disease. This would be negative evidence that scarlet fever is not 
infectious. 2ud. A mother of a family of seven children took her 
youngest with her on a distant visit, and while away this child had 
scarlet fever. She delayed her return several weeks after the com- 
plete recovery of the child, to avoid conveying the contagion to her 
other children. In spite of this precaution and a careful washing- 



VARIOUS SANITARY TOPICS. 149 

up, her other chikh-en all had the disease soon after her return. All 
these were light cases ; but the neighbors knowing what the disease 
was, the famil3' had no visitors and made no visits. Three weeks 
after the complete recovery of the last case, some of these children 
joined other children at pla}^ in a field. One of the children, who 
met these convalescents, took the disease and died in thirty-six hours 
after the first symptom. His sister, who worked two miles distant 
where there were children, attended the funeral. Returning, she 
gave the disease to her emplo3"er*8 children, who all recovered ; and 
she called at a neighbor's house where there were fonr children, all 
of whom took the disease, and two of whom died within forty-eight 
hours of their first sickness. This seems to be positive evidence that 
scarlet fever is infectious. 

We thus, as is illustrated b}- these two histories, have negative 
evidence which seems to indicate that scarlet fever is not infectious, 
and positive evidence which seems to show that the same disease is 
infectious ; and this is true of ever}^ other disease which passes as 
contagious, not excepting small-pox ; for even this disease for many 
years was not thought to be infectious, but was supposed to be due 
to atmospheric infiuences. Sydenham, altliough giving much atten- 
tion to small-pox, did not discover this characteristic of the disease. 

Exact science is far enough advancied to justify us in regarding 
the causes of all infectious diseases as microscopic germs, which, in 
producing the disease, grow and multiply within the animal or human 
organism. On the part of these germs, when they have been intro- 
duced into the system, there is an aggressive power which differs 
with each specific form. To illustrate : The aggressive power of the 
bacillus of anthrax is such that it can successfully and piomptl}' 
attack and produce disease in mammals generally, regardless of 
species. Tuberculosis, experimentally at least, can be made tardily 
to attack almost all of the warm-blooded animals, but some of them 
it attacks uuich more readily and easily than others. Fleuro-pneu- 
monia affects cattle but not horses ; and glanders, horses but not 
cattle. Typhoid fever is a disease of man, and until lately, at least, 
experimenters have failed to produce its characteristic pathology in 
the lower animals. Thus it will be seen that the parasitic power of 
these germs varies with the s[)ecies of the animal that receives them. 

On the part of the organism which is invaded l)y these germs there 
is a power of resistance which varies, not only with the species of 
animals, but with individuals of the same species. For instance, 
that equine scourge, glanders, attacks only forty or fifty per cent of 



150 STATE BOARD OF HEALTH SPECIAL PAPERS. 

horses which have been fully exposed to the natural infection. Small- 
pox attacks a large majorit\' of unprotected human beings who are 
exposed to it ; ^^et there are a few persons who, without vaccination, 
can fully expose themselves to it repeatedly with impunity. With 
diphtheria there is a larger proportion of persons, even within the 
more susceptible period of life, who will not take this disease. 

Not only does the power of resistance var}' with the individual, but 
it varies with the same individual at different times. Sir Thomas 
Watson tells of an old woman who for years without vaccination had 
acted as a nurse for small-pox patients, but who at the age of 84 
died of this disease. In the First Annual Report of the Board, Dr. 
Adams of Litchfield narrates an interesting case of varying indi- 
vidual susceptibilit}'. 

"Scarlet fever visited a family three times, taking one or two at a time, 
passing by a pair of twin sisters, and one of them afterwards nursed in a 
family where it prevailed. Years after, when she had a family of small 
children and seemingly had no possible chance for contagion, she was 
taken down and died with the disease in two or three days, and all of her 
children had it in about tliree days, and one of three died. The other twin 
sister was with her when she died, and attended the funeral, and the chil- 
dren were then sick too. Two years later, with no source of the disease 
possible but the use of some clothing from the other sister's liome, which 
had been in her house for twa years past, she was taken sick and died be- 
fore the rash had time to appear. Her three children also became affected 
from her.'' 

This personal element must never be lost sight of in weighing the 
evidence as to whether a given disease is contagious or not. It should 
be remembered that whether a person shall take an infectious disease 
depends in the first place upon whether he shall be exposed to the 
infection, and secondly upon his individual susceptibility or predis- 
position to the disease. 

We will suppose one hundred children without vaccination, and at 
the most susceptible ages, to be fully exi)oscd to the infection of 
small-pox. Of these one hundred so exposed, eighty or ninet}^ per 
cent at least would contract the disease. If, instead of small-pox, 
they were exposed to diphtheria fully and freely, perhaps not more 
than twenty-five or twenty, and possibl}' not so great a per cent, 
would take the disease. Are we therefore, in diphtheria, to let tlie 
seventy-five or eighty pieces of negative testimony obscure or set 
aside the twenty-five or twenty cases which give positive evidence 
that it is contagious? If the proportion of cases attacked were even 
not greater than five per cent, they still with their accompanying 



VARIOUS SANITARY TOPICS. 151 

histor}' might outweigh in the scale of reason the ninety-five cases 
which failed to take this disease. 

What has been said, it seems, maj- explain the meaning of the 
fact that with many infections diseases it may be observed that very^ 
often persons who have been exposed nevei-theless escape the dis- 
ease ; and it seems that it should be a caution to the public against 
too hasty generalizations drawn from their negative observations. 

NOTES ON DISINFECTANTS. 

Until recently, the true germicidal value of the various agents used 
as disinfectants has been a matter of belief rather than something 
demonstrable b}' strictly scientific methods. We used a substance 
as a disinfectant without having positive proof that it possesses the 
disinfecting power that we ascribed to it, and, on the other hand, 
without an\' one else being able to prove that the agent which we 
used is worthless or otherwise. Latel}', some series of careful and 
exact experiments, made for the purpose of determining the germi- 
cidal power of the various disinfectants, have given us valuable in- 
formation in a much-needed direction, notabh', in this country the 
experiments b}' Sternberg and the Committee on Disinfectants, and 
in Germany those by Koch and others connected with the Imperial 
Board of Health. The following notes are based principally ui)on 
the contributions from these sources. 

Carbolic Acid, though valuable as an antiseptic, is found not to 
be a trustworthy disinfectant. The bacilli of anthrax, containing 
spores,* when subjected to a two per cent aqueous solution of ear- 

*For the general reader an explanation of the meaning of "spores," as used in these "Notes," 
will probal)ly be necessary. In the expcrimf nts to wliicli reference is made, the germ-destroy- 
ing power of the various agents which have been used as disinfectants was determined by 
subjecting to their action certain disease-germs and other micro-organisms, which are closely 
related to the disease-producing germs, and noting the result It will be noticed that these are 
sometimes spoken of as "containing spores," and at other times as "not containing spores." 
For instance, under carbolic acid, "the bacilli of anthra.x containing spores" were not destroyed 
by a two per cent solution in seven days, but "the same kind of bacilli when not containing 
spores were killed in from two to twenty-five minutes" by even a one or two per cent solution. 

The common method ot multiplication of these "germs" is by fission, that is, an individual is 
divided into two, the two into four, and so ou. A second method of multiplication possessed 
by some of these organisms, for instance, the bacilli, is by sporiBcation. Under the micro- 
scope the individual bacillus cell, or "rod," is seen to contain a number of small, round, and 
highly refractive spores. If we might compare the parent bacillus cell to a microscopic pod, 
perhaps we might call the spores the peas in the pod. Under the microscope with a magnifi- 
cation of about 500 diametei-s, our ingenious printer says the bacilU of anthrax look like these 
, and that he has nothing in his case more nearly like their spores than these 

These spores are very tenacious of life, resisting the destructive agencies of 

nature, such as cold, heat, drj-ncss, and the lapse of time, while the germs not containing' 
spores arc much more easily destroyed. 



152 STATE BOARD OF HEALTH SPECIAL PAPERS. 

bolic acid, were not destiw'ed at the end of seven days, and in a five 
per cent solution they were not surely killed in less than forty-eight 
hours. On the other hand, the same kind of bacilli when not con- 
taining spores were killed in Irom two to twenty-five minutes when 
exposed to the action of even a one or two per cent solution. Against 
some particular kinds of contagion, carbolic acid ma^' be safely used. 
Thus, it is found that solutions of onh' one or two per cent will de- 
stroy the virulence of certain septic and purulent matters and the 
micrococci of fowl cholera, and, according to tlie showing of Schill 
and Fischer, a five per cent solution may be relied upon to destroy 
the bacillus of tuberculosis even when containing spores, if permitted 
to act twenty-four hours. 

Carbolic acid in oil or alcohol is deprived of all its value as a dis- 
infectant. A five per cent solution in oil did not afiect the virulence 
of the spores of the bacilkis anthracis iu one hundred and ten days, 
but the bacilli free from spores were killed in six daj's ; yet the same 
results in the same length of time were attained with pure olive oil. 
Sulphate of Iron. This salt, which has been extensivel}' used as a 
disinfectant, has shown, in the experiments which have been made 
with it, no power of destroying disease germs. It is worth some- 
thing as a deodorizer of offensive substances and will retard the 
putrefactive processes in such material, but when a germicide is 
needed some other agent should be used. 

Sulphate of Zinc has but feeble disinfecting power. A twenty per 
cent solution, with Sternberg, failed to destroy the micrococcus of 
pus in two hours, and with Koch, a five per cent solution was not 
fatal to anthrax spores in ten days. 

Chloride of Zinc. Koch pronounces it utterly worthless as a dis- 
infectant. A five per cent solution did not affect the vitalitj' of the 
spores of the bacillus of anthrax in a month. The later experiments 
of Sternberg indicate that zinc chloride in the proportion of five per 
cent solution may be relied upon to destroy micro-organisms in the 
absence of spores, but wiicn the solution is added to an etjual quan- 
tity of liquids to be disinfected a ten per cent solution should be 
used. In a given infectious disease, without positive knowledge of 
the character of the micro-organism to be acted upon, this salt must 
be considered as having doubtful gerniii-idal value. 

Sulphate of Copper. In the German experiments a five per cent 
solution was ineffective to destroy anthrax spores in ten days, though 
the rapidity of their development was somewhat delayed. Sternberg 



VARIOUS SANITARY TOPICS. 153 

found that a solution of the same strength would destroy' the micro- 
coccus of swine plague and that from an acute abscess. He calls it 
a valuable germicide, and says that it ma}' be safely recommended 
for the destruction of material not containing spores, but further 
8a3's that none of the metallic sulphates can be relied upon to de- 
stroy spore-bearing pathogenic organisms. 

Sul2)hUes, Bi/j^osuljjhites caul Bisuljihiies. The first two classes of 
substances have no value as germicides and the last has only feeble 
powers. 

Potassium Permanganate. In the experiments of Koch, a five per 
cent solution destroyed the vitality of anthrax spores in twent^'-four 
hours, but a one per cent solution failed to injure them in twice as 
long. In the presence of a large amount of organic matter the per- 
manganate is quickly decomposed before it can exert its germicidal 
powers. Sternberg says : "It is evident that while potassium per- 
manganate has decided germicide and antiseptic power, it is not 
generally applicable for purposes of disinfection, because of the 
readiness with which it is decomposed by organic matter. It is, 
however, a prompt and valuable deodorizer." 

Chloride of Lime. This is popularl}- known as "bleaching pow- 
der," and is a ver}' efficient disinfectant, and, moreover, is very 
cheap. Germs of all kinds, inclwdiug those containing spores, are 
quickly destroyed by it. Dr. Duggan, of the Committee on Disin- 
fectants, says : "There are ver^- few purposes to which disinfectants 
are applied, that are not fulfilled by this solution of one to one 
hundred of bleaching-powder. It is not poisonous, does not injure 
clothing, bedding, etc., and is almost without cost, since bleaching- 
powder is worth onl}' about five cents a pound." Chloride of lime 
should be kept in air-tight cases, and for most purposes should be 
used in solution made as it is wanted. (See Sol. A.) 

Solution of Chlorinated Soda (Liquor Sodie Chlorinate, Labai*- 
raque's Solution). In solutions of the same strength as those of the 
chloride of lime, it is of equal eflSciency as a disinfectant. As a dis- 
infectant and deodorizer, it is less disagreeable than the chloride of 
lime solution for various purposes in the sick-room. Preparations of 
Labarraque's Solution do not keep well, consequently much of that 
whidi is on the market is not to be depended upon. 

Mercxirlc Chloride (Corrosive Sublimate). Tins is a universal 
destroyer of disease germs and germ spores, and is the most elli- 
cicnt chemical disinfectant known. 



154 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

Kocli found that an aqueous solution of 1 : 1,600,000 had an ap- 
preciable effect in retarding the growth of anthrax bacilli, and that 
1 : 330,000 would cause a complete arrest of development. The 
vitality of the spores of the same bacilli, dried on silk threads, was 
destroyed in ten minutes by the action of a 1 : 20,000 solution. For 
practical use upon larger masses of infected material, a solution of 
1 : 1,000. or, in the absence of spores, 1 : 5,000 is recommended. 

Sternberg's estimate of the value of this agent as a germicide is 
in accord with that of Koch, though his experiments seem to show 
the need, in practical disinfection, of somewhat stronger solutions. 
The following are his conclusions : 

"Mercuric chloride, in aqueous solution, in the proportion of 1 : 
10,000, is a reliable agent for the destruction of micrococci and bacilli 
in active growth, not containing spores ; and in the proportion of 1 : 
1,000 it destroys the spores of bacilli, provided that the micro-organ- 
isms to be destroyed are fairl}' exposed to its action for a sufficient 
length of time. 

A standard solution of 1 : 1,000 ma}' be safely recommended for 
the disinfection of bedding and clothing which can be washed ; for 
washing the floors and walls of infected apartments ; for disinfect- 
ing the hands and instruments of surgeons and gynecologists ; and 
as a disinfecting wash for superficial wounds or mucous surfaces. 
For continuous application to wounds, etc., a solution of 1 : 10,000, 
or less, should be effective. 

A standard solution of 1 : 500, with the same quantity of potas- 
sium permanganate, maybe safelj' recommended for the disinfection 
of liquid fecal discharges, and other fluid mateiial supposed to con- 
tain 'disease germs,' provided the time of exposure is not less than 
two hours, and the quantity of material to be disinfected is not in 
excess of that of the standard solution used." 

The only drawbacks to the general use of corrosive sublimate as a 
disinfectant are its coagulating action on albuminous matter and its 
well-known poisonous nature. On account of the former quality, 
when it is added to albuminous masses, as in the case of tuberculous 
sputum to be disinfected, the outside coagulated coating sometimes 
protects the inner portions from the action of the disinfectant. On 
account of its poisonous qualities, the Board of Health does not feel 
justified in recommending its poi)ular use. When used it should be 
under the direction of a physician, health officer, or other intelligent 
and responsible person ; and yet when in the form of Solution B. it 



VARIOUS SANITARY TOPICS. 155 

would be only by gross carelessness that a dangerous accident could 
occur. On account of its disagreeable metallic taste a quantit}- great 
enough to produce a dangerously poisonous effect would not be likely 
to be swallowed. One ounce of Solution B. contains not quite one 
grain of the sublimate, and one drachm contains a little less than ^ 
grain. Solution B. mixed half and half with water, may always be 
used freely with safety to wash down the woodwork of rooms and 
furniture ; and clothing which has been disinfected in a solution of 
1 : 1000 is perfectly safe to the wearer after a subsequent washing, 
or rinsing, and drying, f^.xperiments made b}' Dr. Vaughan show 
that a small quantity of earth or soil of an}- kind fixes and removes 
all the corrosive sublimate in a solution filtering through it, there- 
fore, the fear is groundless that wells may be poisoned by the use of 
this disinfectant in neighboring vaults. Solutions of corrosive subli- 
mate should be kept in earthen-ware or wood, and not put into 
metallic vessels of any kind, or poured through lead pipes, as the 
mercurial salt ra[)idly corrodes and destroys them. 

Dry Heat. The value of hot air for disinfection and its applica- 
bility to these purposes is summed up in the following conclusions of 
Koch and "NVoltlhuegel : 

''1. A temperature of 100° C. (212° F., dry heat), maintained 
for one hour and a half, will dcstro}' bacteria which do not contain 
spores. 

2. Spores of mould-fungi require for their destruction in hot air a 
temperature of from 110°-llo° C. (230°-23y° F.) maintained for 
one hour and a half. 

3. Bacillus spores require for their destruction in hot air a tem- 
perature of 140° C. (284° F.) maintained three hours. 

4. In dry air the heat penetrates objects so slowly that small 
packages, such as a pillow or small bundle of clothing, are not dis- 
infected after an exposure of from three to four hours to a tempera- 
ture of 140° C. (284° F.) 

5. Exposure to a temperature of 140° C. (284° F.) in dry air for 
a period of three hours, injures most objects requiring disinfection 
(clothing, bedding, etc.) to a greater or less degree." 

Moist Heat. The experimental work which has been done shows, 
that for disinfecting purposes, moist heat has very great advantages 
over dry heat, in that the disiufeetion can be accompjished with a 
lower temperature and with not nearly so much danger of injuring 
infected fabrics, which arc subjected to disinfection. 



156 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

In the absence of spores, all known micro-organisms are quickly 
killed in boiling water, and, though the spores of certaiu harmless 
organisms will withstand prolonged boiling, it may safely be said 
that the spores of all disease germs are infallibly killed by boiling 
for half an hour. 

Koch, Gaffky, and Loefler found that the most refractory of spores 
when subjected to the aclion of steam at a temperature of 105°C. (221° 
F.) for ten minutes were destroyed, and Sternberg gives testimony 
confirmatory of the above, and further saj's, when speaking of the 
disinfecting power of steam under pressure, that ''at twenty pounds 
pressure the temperature is about 230° Fahr. (105° C.) ; at twenty- 
five pounds, it is about 240° Fahr. ; at thirty* pounds, it is 250° 
Fahr. Moist heat at the lowest temperature named destro3's the 
most resistant spores in twenty minutes, while a temperature of 240° 
Fahr. is eftective almost immediateh-." 

Sulphur Fumigation. Both the American and the German experi- 
menters have shown that we cannot depend upon sulphurous acid to 
destroy spore-bearing germs, and therefore the latter are disposed 
to abandon its use entirely as a disinfectant. Sternberg says, in ref- 
erence to this, and in view of his own experiments : "I am not ready 
to go to this length, and to i-ecommend the abandonment of an agent 
which enjoys the confidence of practical sanitarians for the destruc- 
tion of the infection of small-pox, of scarlet fever, of diphtheria, of 
cholera, and of yellow fever, upon the ground that it fails to destroy 
the spores of the anthrax bacillus, or of B. subtilis ; for the truth 
of the germ theory has not yet been definitely established for any 
one of the diseases named, and Wernitz has shown the power of 
this agent to neutralize non-living ferments. Admitting, however, 
as I do, the great probability that the infectious agent in these dis- 
eases is a living germ, we have good reason for believing that spores 
are not formed in any one of these diseases. We must not, then, be 
too exacting with reference to this agent until we are able to recom- 
mend something better in its place for the purposes to which it is 
commonly applied, viz., for the disinfection of apartments and 
ships." 

One thing we may be assured of, and that is tliat the sliglit fumi- 
gation which is so often given to rooms in which there have been 
cases of the infectious diseases is entirely iiarmless to all forms of 
disease germs, even those which do not produce spores. That we 
may have any assurance of success with this form of disinfection, 



VARIOUS SANITARY TOPICS. 157 

the room to be disinfected must have a truly massive dose of the 
sulphurous acid gas. Three pounds of sulphur at least to the 1000 
cubic feet of space, instead of the lesser quantities hitherto recom- 
mended, should be burned and care taken that the room to be dis- 
infected is made as tight as possible by closing all openings and 
pasting strips of paper around doors and windows. The wood- work, 
furniture, and, when possible, the walls of the room should be 
washed with a solution of corrosive sublimate or other liquid disin- 
fectant either before or after the fumigation, and all bedding and 
other articles that can be subjected to liquid disinfection should be 
immersed (in the sick-room) in a plentiful supply of Solution A. or 
Solution B, one half strength. Bedding and all clothing which can 
be treated only with the gaseous disinfection must be spread out or 
hung out so as to expose all parts as thoroughly as possible, for the 
sulphurous acid gas has only a feeble power of penetrating masses 
of fabrics. 

The sulphur should be put into an iron pan or other vessel, sup- 
ported on bricks placed in a wash-tub containing a little water, and 
set on fire with a few live coals, or by pouring over it a little alcohol, 
which mav be fired with a match. 



Solution A. 



Chloride of Lime, 4 ounces. 

Water, 1 gallon. 

Mix. Cost about two cents, or fifty cents a barrel. This is about 
a three per cent solution. 

Solution B. '■'Purple Solution." 

Corrosive Sublimate, 2 drachms. 

Permanganate of Potash, 2 drachms. 

Water, 1 gallon. 

Mix and dissolve. Label, Poison! Cost, two or three cents a 
gallon, when the chemicals are bought by the pound. 

The permanganate of potassium in this solution is used to give it 
color as a precaution against mistakes. It also, in this quantity, in- 
creases the deodorizing qualities of the solution. This is approxi- 
mately a 1 : 500 solution of the sulilimatc ; therefore, mixed with 
an equal quantity of water or liquids to be disinfected it gives us a 



158 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

1 : 1000 mixture. One ounce of this solution contains very nearly 
one grain of the corrosive sublimate. 

Solution C. '■'-Blue Solution." 

Corrosive Sublimate, 4 ounces. 

Sulphate of Copper, 1 pound. 

Water, 1 gallon. 
Mix and dissolve. Label, Poison! 

This is sixteen times stronger than Solution B. and is intended as 
a standard solution, from which, b}' dilution with water, a solution of 
the same strength as Solution B may be made. To make from it a 
solution of the proportion of 

1 : 500, add 8 ozs. to 1 gallon of water, 
1 : 1000, add 4 ozs. to 1 gallon of water, 
1 : 2000, add 2 ozs. to 1 gallon of water, 
1 : 4000, add 1 oz. to 1 gallon of water. 

Solution D. 

Labarraque's Solution, 1 pint, 

Water, 1 gallon. 

Mix. Cost, about twenty-five cents. 

Solution E. 

Carbolic acid, 7 ounces,* 

Water, 1 gallon. 

Mix. This is approximately a five per cent solution, or in the pro- 
portion of 1 : 21. 



In 1884, the American Public Health Association appointed a 
committee to investigate the subject of disinfectants, and to give the 
results of their work in the form of a report. A series of experi- 
ments were carried on b}' the committee to test the value of the 
various disinfectants. Their report is very valuable, but is too 
lengthy to be given in this connection ; but their conclusions, given 

*ScTcn ounceH of the 00 per cent oarbolic acid. 



VARIOUS SANITARY TOPICS. 15'J 

on its last pages, are presented below, with the addition of notes 
enclosed in parentheses, which refer to the preceding formuhu. 

The most useful agents for the destruction of spore-containing in- 
fectious material are, — 

1. Fire. Complete destruction by burning. 

2. Steam under pressure. 110° C. (230° Fahr.) for ten minutes. 

3. Boiling in water for one hour. 

4. Chloride of lime. A four per cent solution (about five ounces 
to one gallon of water). 

6. Mercuric chloride. A solution of 1 : 500 (Solution B). 

For the destruction of infectious material which owes its infecting 
power to the presence of micro-organisms not containing spores, the 
committee recommends, — 

1. Fire. Complete destruction b}' burning. 

2. Boiling in water for half an hour. 

3. Dry heat. 110° C. ^230° Fahr.) for two hours. 

4. Chloride of lime. One to four per cent solution. (Solution A.) 
0. Solution of chlorinated soda. Five to twenty per cent solution. 

6. Mercuric chloride. A solution of 1 : 1000 to 1 : 4000. (Solu- 
tion B, 1 part to one of water=l : 1000 ; 1 part to 3=1 : 2000 ; 1 
part to 7=1 : 4000.) 

7. Sulphur dioxide. Exposure for twelve hours to an atmosphere 
containing at least four volumes per cent of this gas, preferably in pres- 
ence of moisture. 

8. Carbolic acid. Two to five per cent solution. (Solution E.) 

9. Sulphate of copper. Two to five per cent solution. 

10. Chloride of zinc. Four to ten per cent solution. 

The committee would make the following recommendations with 
reference to the practical application of these agents for disinfecting 
purposes. 

FOR EXCRETA. 

(a) In the sick room. For spore-containing material: 

1. Chloride of lime in solution, four per cent (about five ounces to 
one gallon of water, or use Solution A). 

2. Mercuric chloride in solution, 1 : 500 (Solution B). In the ab- 
sence of spores : 

3. Carbolic acid in solution, five per cent. 

4. Sulphate of copper in solution, five per cent. 

5. Chloride of zinc in solution, ten per cent. 



160 STATE BOARD OF HEALTH SPECIAL PAPERS. 

(&) In priv}' vaults : 

Mercuric chloride in solution, 1 : 500, (Solution B.) 

(c) For the disinfection and deodorization of the surface of masses 
of organic material in privy vaults, etc. : 
Chloride of lime in powder. 

FOR CLOTHING, BEDDING, ETC. 

(0) Soiled under-clothing, bed linen, etc. : 

1. Destruction by fire, if of little value. 

2. Boiling for at least half an hour. 

3. Immersion in a solution of mercuric chloride of the strength of 
1 : 2,000 for four hours. (Solution B, one part to three of water 
= 1: 2,000.) 

4. Immersion in a two per cent solution of carbolic acid for four 
hours (two and one-half ounces to one gallon of water) . 

(b) Outer garments of wool or silk, and similar articles, which 
would be injured by immersion in boiling water or in a disinfecting 
solution : 

(1 ) Exposure to dry heat at a temperature of 110° C. (230° Fahr.) 
for two hours. 

(2) Fumigation with sulphurous acid gas for at least twelve hours, 
the clothing being freely exposed, and the gas present in the disin- 
fecting chamber in the proportion of four volumes per cent. 

(c) Mattresses and blankets soiled b}' the discharges of the sick : 

1. Destruction by fire. 

2. Hxposurc to super-heated steam — 25 lbs. pressure — for one 
hour. [Mattresses to have the cover removed or freely opened.] 

3. Immersion in boiling water for one hour. 

4. Immersion in the "blue solution," two liuid ounces to the gallon 
of water. (Solution C.) 

FURNITUKE, AND ARTICLES OF WOOD, LEATHER AND PORCELAIN. 

Washing several times repeated, with, — 

1. Solution of mercuric chloride 1 : 1,000 (Solution C, four ounces 
to one gallon of water) . 

2. Solution of chloride of lime, one per cent (Solution A one 
part, water two parts). 

3. Solution of carbolic acid, two per cent (two and one-half 
ounces to one gallon of water). 



VARIOUS SANITARY TOPICS. 161 



FOR THE PERSON. 

The hands and general surface of the bodies of attendants, of the 
sick, and of convalescents at the time of their discharge from hos- 
pital : 

1. Solution of chlorinated soda diluted with nine parts of water — 
1 : 10—. (or Solution D=l : 9). 

2. Carbolic acid, two per cent solution. (Two and one-half 
ounces to one gallon of water). 

3. Mercuric chloride, 1 : 1000; recommended only for the hands, 
or for washing away infectious material from a limited area, not as. 
a bath for the entire surface of the body. (Solution B one part,, 
water one part) . 

FOR THE DEAD. 

Envelop the body in a sheet thoroughly saturated with, — 

1. Chloride of lime in solution, four per cent (or Solution A).. 

2. Mercuric chloride in solution, 1 : 500. (Solution B.) 

3. Carbolic acid in solution, five per cent (or Solution E). 

FOR THE SICK-ROOM AND HOSPITAL WARDS. 

(a) While occupied, wash all the surfaces with, — 

1. Mercuric chloride in solution, 1 : 1000. (Solution B with wa 
ter half and half, or Solution C, four ounces to one gallon of water.) 

2. Chloride of lime in solution, one per cent. (Solution A one 
part, water two parts.) 

3. Carbolic acid in solution, two per cent. (Two and one-half 
ounces to one gallon of water.) 

(6j When vacated, fumigate with sulphur dioxide for twelve 
hours, burning three pounds of sulphur for every one thousand cubic 
feet of air space in the room ; then wash all surfaces with one of the 
above-mentioned disinfecting solutions, and afterwards with soap- 
and hot water; finally throw open doors and windows, and ventilate 
freeh'. 

FOR MF.RCHANDISE AND THE MAILS. 

The disinfection of merchandise and the mails will onh- be re- 
quired under exceptional circumstances ; free aeration will usually 
be sufllcient. If disinfection seems necessary, fumigation with 

11 



162 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

sulphur dioxide, as recommended for woolen clothing, etc., will be 
the only practicable method of accomplishing it. 

RAGS. 

(a) Rags which have been used for wiping awa}' infectious dis- 
charges should at once be burned, 

(b) Rags collecting for the paper-makers during the prevalence 
of an epidemic should be disinfected before the}' are compressed in 
bales, by — 

1. Exposure to super-heated steam — twenty-five pounds pressure 
— for ten minutes. 

2. Immersion in boiling water for half an hour. 

(c) Rags in bales can only be disinfected b}- injecting super- 
heated steam — fiftj' pounds pressure — into the interior of the bale. 
The apparatus used must insure the penetration of the steam to 
every portion of the bale. 

SHIPS. 

(a) Infected ships at sea should be washed in ever}' accessible 
place, and especiall}' the localities occupied by the sick, with — 

1. Solution of mercuric chloride 1 : 1000. (Solution C four 
ounces to one gallon of water.) 

2. Solution of chloride of lime, 1 per cent. (Solution A one 
part, water two parts.) 

3. Solution of carbolic acid, two per cent. ( Two and one-half 
ounces to one gallon of water. ) 

The bilge should be disinfected by the liberal use of a strong 
solution of mercuric chloride; the concentrated solution — "blue 
solution " — of this salt with cupric sulphate may be used. (Solu- 
tion C.) 

(6) Upon arrival at quarantine station, an infected ship should 
at once be fumigated with sulphurous acid gas, using three pounds 
of sulphur for every 1000 cubic feet of air space; the cargo should 
then ])e discharged on lighters ; a liberal supply of the concen- 
trated solution of mercuric chloride (Solution C) should be thrown 
into the bilge, and at the end of twenty-four hours the bilge water 
should be pumped out and replaced with pure sea water ; this should 
be repeated. A .second fumigation, after the removal of the cargo, 
is to be recommended ; all accessible surfaces should be washed 
with one of the disinfecting solutions heretofore recommended, and 
subsequently with soap and hot water. 



VARIOUS SANITARY TOPICS. 163 

CHEESE, MILK AXD ICE CREAM POISONING. 

During the past year several eases of poisoning frono milk and its 
products have come to the attention of the Board. 

Poisoning on a small scale occurred in Bangor from the use of 
milk. It seems that four children in one family and one in another 
made their breakfast chiefly of milk purchased of a grocer. The 
milk was said to have been brought in from the country that same 
morning. Three hours after their breakfast, at different schools, 
the children were attacked with vomiting and later with diarrhoea. 
The grocer took one quart, which was used in coffee, and had an 
attack of vomiting an hour or two afterward. Another family, who 
had the fourth quart out of this gallon-can, used it in coffee and was 
not affected by it. The Board received a very small quantity of 
this milk, three or four drachms only being obtainable, but, as there 
was doubt iu regard to the genuineness of this small specimen, a 
series of biological tests which was begun was discontinued after 
yielding only negative results. 

Another instance of poisoning on a much larger scale occurred at 
Eastport. July 23, 1886, at a church sociable in that town, many 
persons partook of ice cream. The company dispersed about half 
past ten in the evening, and in an hour afterwards some of them 
became very sick, and by midnight all of the physicians in the place 
were on active duty. About sixt}' persons were made sick, and the 
condition of man}' of them became alarming. The symptoms 
usually began with nausea and vomiting, and the vomiting in many 
cases was very severe and prolonged. Diarrhoea came on later, and 
the purging was severe in some cases. Other symptoms were 
abdominal pains, a burning sensation in the stomach, pain and 
cramps in the muscles of the arms and legs, anxious countenance, 
coldness of the extremities, and a pulse feeble and, in some cases, 
almost imperceptible. 

Those only who partook of the ice cream which was flavored with 
vanilla became sick. Those who ate of the lemon-flavored cream 
were spared. 

Cases of poisoning of the kinds which have been indicated have 
for a long time been known, and their occurrence is somewhat fre- 
quent. The close similarity of the symptoms to those produced by 
some of the mineral poisons, notably arsenic, has often created sus- 
picions of the accidental or intentional addition of these non-organic 



104: STATE BOARD OF HEALTH — SPECIAL PAPERS. 

poisons. Chemical analysis in niau\' of these suspicious cases has 
given only negative results. In the absence of any detectable min- 
eral poison, the symptoms have variously been ascribed to the flavor- 
ing extracts, particularly to the vanilla ; and, in the case of milk and 
its products, to poisonous plants eaten by the cows, and to certain 
changes in the milk, curd or cheese due to the earlj' stages of fer- 
mentation or decomposition. As regards the first, the observation 
has often been made that, in ice cream poisoning, it is usually- the 
vanilla flavoring which bears the weight of suspicion, for the reason 
that those who had eaten of only the cream which was flavored with 
extracts other than the vanilla were not made sick. On the other 
hand, experiments on man and animals with the suspected vanilla 
extract have usuallv been followed with no symptoms of poisoning. 
Neither have the attempts to fix the blame upon the cows been suc- 
cessful. In regard to the third suggestion, that relating to a sup- 
posed change in the milk after it leaves the cow, there is more to 
support it. Twenty 3ear3 ago it was discovered that in animal and 
human tissues after death there occurred an alkaloidal substance 
apparently generated b}- the retrogi'ade metamorphosis of the ele- 
ments of the dead animal tissues. In subsequent years it became 
apparent that there are many of these jjtomaines, as the}- are called, 
and their isolation and experiments with them show that some of 
them are capable of producing symptoms similar to the more poison- 
ous vegetable alkaloids. 

It was said by a leading German toxicologist in 1882, that of the 
ptomaines then known none produced symptoms, when tested upon 
animals, which closelj' resemble those of cholera morbus, as we see 
in a marked form in some cases of cheese and fish poisoning. It 
was reeervcd for Dr. Vaughan, of Ann Arbor, Mich., to discover an 
alkaloid which produces these choleraic symptoms, and which un- 
doubtedly is the noxious agent in most of the cases of cheese, milk 
and ice-cream poisoning. Two years ago, after a long and close 
investigation, he succeeded in isolating from some samples of cheese 
which had produced alarming symptoms in many persons, a highly 
poisonous ptomaine, to which he gave the name tyrotoxicon, (cheese 
poison). The effects of this poison were repeatedly demonstrated 
upon some of his students, who offered themselves as subjects of 
experimentation, and upon himself. The symptoms produced were 
found to agree closely willi those which were produced in the persons 



VARIOUS SANITARY TOPICS. 165 

who liad eaten the poisonous clieese, and were dryness and constric- 
tion of the fauces, nausea, retching, vomiting and purging. 

For an account of furtlior investigations and experiments in this 
direction, I quote at consi(k'ral)le length from a contribution by Dr. 
Vaughan to the Sanitary News of July 24, 1886. 

"Last November, a student brought to me a four ounce bottle 
partly filled with milk, which had stood lightl\' closed with a glass 
stopper for about six months. From this I succeeded in isolating 
the same poison. It was recognized by its crystalline appearance, 
and by its efTect upon myself. It was presumed that this milk was 
normal in composition when first obtained, but of this we could not 
be certain. 

"I then put several gallons of normal milk in perfect!}' clean bottles 
■with glass stoppers, and allowed these to stand in my work room. 
From lime to time a bottle was opened, and the test for tj'rotoxicon 
was made. These tests were followed by negative results, until 
about three months after the experiment was begun. I then suc- 
ceeded in getting the poison from one of the bottles. The method 
of testing for it was as follows : The coagulated milk was filtered 
through heavy Swedish filter paper. The filtrate was colorless, and 
decidedly acid in reaction. It was rendered feebh' alkaline by the 
addition of potassium hydrate, then agitated with ether. After sep- 
aration, the ethereal layer was removed with a pipette, allowed to 
run through a dry filter paper to remove a flocculent, 'white substance 
which floated in it, and then allowed to evaporate spontaneously. If 
necessary, this residue was dissolved in water and again extracted 
with ether. On the evaporation of the ether, the tyrotoxicon was 
recognized by its crystalline appearance, by its odor, and by placing 
a small bit on the tongue. As the ether takes up some water, there 
is usually enough of the latter left after the spontaneous evaporation 
of the ether to hold the poison in solution, and in order to obtain 
the crystals, this aqueous solution must be allowed to stand for some 
hours in vacuo over sulphuric acid. 

"From one-half gallon of the milk, there was obtained quite a con- 
centrated atpieous solution of the poison, after the spontaneous evap- 
oration of the ether. Ten drops of this solution placed in the mouth 
of a small dog three weeks old caused, within a few minutes, froth- 
ing, retching, the vomiting of frothy fluid, muscular spasm over the 
abdomen, and after some hours watery stools. The next da}' the 
dog seemed to have partially recovered, but was unable to retain any 



166 STATE BOARD OF HEALTH SPECIAL PAPERS. 

food. This condition continuing for two or three days, the animal 
was killed with chloroform. No examination of the stomach was 
made. 

"It ma}- be remarked here that I have elsewhere pointed out the 
necessity of using pure ether for these extractions, as some samples 
of ether contain an irritating, ptomaine-like substance. 

''June 13, 1886, I received from Dr. Henry B. Baker, Secretary of 
the Michigan State Board of Health, a pint bottle about two-thirds 
full of melted ice cream, with the request that I analyze it, as some 
eighteen persons had been seriouslv affected by eating it. Dr. 
Baker also sent some of the vanilla which had been used as flavor- 
ing. It Avas thought that the poison would be found in the vanilla, 
because some lemon ice cream furnished at the same gathering had 
not affected those who ate it. As the readiest means of deciding 
this, my assistant, Mr. Novie, and m^'self took at first thirty drops 
each of the vanilla extract. No ill eflTects following this, Mr. Novie 
took two teaspoonfuls more, with no results. This settled the ques- 
tion of the poisonous nature of the vanilla more satisfactorily than 
could have been done by a chemical analysis. 

''We then added some distilled water to the cream and, after 
thorough agitation, filtered it. The filtrate was tested for tyrotoxicon 
by the method already given. The aqueous solution, after the 
spontaneous evaporation of the ether, was given to a cat. Within 
ten minutes the cat began to retch, and soon it vomited. This 
retching and vomiting continued for two hours, during which time 
the animal was under observation, and the next morning it was 
observed that it had passed watery stools. After this, although the 
cat could walk about the room, it was unable to retain any food. 
Several times it was observed to lap a little milk, but on doing so it 
would immediately begin to retch and vomit. Even cold water pro- 
duced this effect. This condition continuing, after three days the 
animal was placed under ether and its abdominal organs examined. 
We certainly expected to find marked inflammation of the stomach. 
But we really did find the stomach and small intestines filled with a 
frothy, serous fluid, such as had formed tiie vomited matter, and the 
mucous membrane very white and soft. There was not the slightest 
redness anywhere. The liver and other abdominal organs seemed 
to be normal." 



VARIOUS SANITARY TOPICS. 167 

OTHER KINDS OF POISOXIXG. 

Other kinds of poisoning, the symptoms of which are similar to 
those of cheese, milk and ice cream poisoning, and which are sup- 
posed to depend upon incipient putrefactive changes, are poisoning 
from meat, sausage, fish, and "shell-fish." Each of these different 
kinds of poisoning has a set of symptoms which distinguishes it 
somewhat from the other forms, and still there is a general similarity 
of phenomena which would suggest a relationship of causes. 

The similarity of symptoms in some of these cases to the chol- 
eraic sj'mptoms which follow cheese, milk and ice cream poisoning 
will be seen in the description of some cases of meat-poisoning 
which occurred last summer in Augusta. 

A family had a meat soup for dinner. A neighbor wiio lives in 
another part of the house had a bowl of the soup sent in to her. About 
twenty minutes after dinner three visitors from a neighboring town 
came in. These three ate of the soup. In about two hours the 
mistress of the house, the maker of the soup, was suddenly taken 
with intense burning in her throat, thirst, a "deathly feeling at the 
stomach," vomiting, coldness of the extremities and, later, purging. 
A little later the others were attacked with similar symptoms, all 
excfept a little one who did not like soup and ate none. Moreover, 
the doctor who attended them said that two cats that had received 
their post-prandial portion of the soup were attacked with vomiting 
and diarrhoea, and were reeling about. All recovered, cats included. 

Disregarding the cases of poisoning which result from meat which 
has been rendered unwholesome by disease before the death of the 
animal, and those which occur on account of poisons, principally 
vegetable, which may have been eaten with impunity by the animal, 
but which, stored up in the tissues, may injuriously affect man, there 
is, in a narrower sense, a class of cases of meat-poisoning of which 
the cases given may serve as a type. 

Sausage poisoning occurs occasionally in this country, but is of 
much more frequent occurrence in Germany, where the quantity of 
meat consumed in this shape and the variety of sausages are much 
greater than with us. Certain kinds of sausages have more fre- 
quently than others acted poisonoush', and quite often it has been 
those which are of immense size, or those which are made with blood 
and liver. In these, the process of drying and curing with smoke 
goes on slowly and the interior of the mass is penetrated only incom- 



168 STATE BOARD OF HEALTH SPECIAL PAPERS. 

pletely. It has repeatedly been found after poisoning with these 
sausages that while the central portion is very poisonous the peri- 
pheral portions are less so or entirely harmless. It is somewhat 
characteristic of sausage poisoning that the symptoms occur late ; 
while they may come on in an hour or two, in the great majority of 
cases they do not appear until after from twelve to twent^'-four 
hours. Sausage-poisoning is also characterized b}' a greater mor- 
tality than in the preceding forms of poisoning. In the cases of 
meat, cheese, milk and ice cream poisoning, which are thought to be 
due to an alkaloid of decomposition, death is rare ; but, in the Ger- 
man statistics, a death rate of from 23 to 43 per cent is given for 
the earlier records, and a somewhat lower mortality for the later 
cases.* 

The most of our knowledge of fish-poisoning has come from 
Russian observers. In their country, this kind of poisoning seems 
to have occurred with exceptional frequency', and to have been fol- 
lowed by a high rate of mortality. 

Poisoning from "shell-fish" — oysters, clams, lobsters, etc. — is 
not so very rare, in its lighter forms, with us. It may occur in an 
exanthematous form, in which the cutaneous rash is the most marked 
symptom, or may take principally the form of gastro-intestinal irri- 
tation. Exceptionally the poisoning assumes the paralytic or apo- 
plectic form and may rapidly lead to a fatal termination. 

PTOMAINES AND LEUCOMAINES. 

For our knowledge on these subjects we have to turn mostly to 
the Italian, French and German literature, for in our own language 
there is but little to be learned. The name " Ptomaines" has been 
used to designate certain basic substances which arise during the 
decay of animal matters. This name was api)lied to these bodies 
first b}' Selmi, the Italian toxicologist, in 1872, but as early at least 
as 18GG, these bodies had been recognized b}' chemists. In their 
chemical reactions, as well as in their physiological actions, they 
bear a strong resemblance to the vegetable alkaloids. For instance, 
atropin, hyosc^'amin, digitalin, nicotin, morphine, curariii, coniin, 
and otiiers, all have their analogues among the ptomaines. The 
fact that some of these alkaloids of uniinal extraction resemble 
somewhat closel}', both chemical)}' and physiologically, some of the 



*Un8cmann. Real-Encyclopaedie dcr gegsamintou Iltilkuiidc. Vol. XV, p. 7. 



VARIOUS SANITARY TOPICS. 169 

vegetable alkaloids was earl}- recognizefl as having an important 
bearing upon medical jurispnidence, and since then the records of 
criminal courts have contributed quite a collection of cases in which 
an alkaloid found in the cadaver, supposed to be of vegetable origin 
and administered with criminal intent, has been shown to be a pto- 
maine originating in post-mortem changes. The first case of this 
kind* was the criminal process which followed the death of Gen. 
Gibbone, in which an alkaloid supposed to be delphinin was found, 
but which Selmi showed to be a ptomaine. In a second Italian case, the 
chemical experts believed the}' had discovered morphine, but Selrai 
and Casali were able to prove that it was nothing more than ai pto- 
maine. In a third and a fourth case, the alkaloids which were 
detected were supposed to be respectively strychnin and coniin, but 
they were shown to be ptomaines. 

The chemical peculiarities of the ptomaines which have been de- 
scribed by different chemists are so various that we may regard it 
as established that there is a pretty large number of these bodies. 
A few of them have been isolated as well-defined chemical individ- 
uals, but more of them have been recognized b}' their chemical or 
physiological action in probably an impure state. It is thought that 
many of them are verj' unstable and fleeting in their nature, so that 
they easih' elude the efforts of the chemist to detect them. The late 
works of Brieger have shown that in the different stages of decom- 
position different basic products are constituted, that man}' ptomaines 
in time completely disappear and others take their places, and that 
certain ptomaines, at first present in ouh' sparing quantities, increase 
rapidly after the disappearance of certain others which seemed to 
have stood in the way of the first. The instabilit}' of these substances 
would serve to explain certain facts which have been observed in 
connection with some cases of supposed ptomaine-poisoning. For in- 
stance, in the cases of milk-poisoning in Bangor, of the four families 
who used from the poisonous can, those wiio took the milk unheated 
suffered, while, of the two families who used the milk in coffee, onl}"^ 
one person was affected, and he only sligiilly. Sausages which were 
intensel}' poisonous before cooking have been found to lose in large 
part their dangerous qualities after boiling. 

Of the i)tomaines which are actively poisonous, some are developed 
only in the earliest stages of decomposition, before foul smells or other 

♦IIuscuijiiiu. Rcal-£ucyclopa;die dor gcssiuimtcu Ilcilkuude. Vol. XI, p. 160. 



170 STATE BOARD OF HEALTH SPECIAL PAPERS. 

marked evidence gives indication of the change, while others arise only 
in the advanced stage of decomposition. In the decomposition of 
fish the poisonous qualities are most marked in the earliest stages.* 
In poisonous sausages, too, the poison seems to be developed 
during an earl}' stage of decomposition, and, while advanced 
decomposition does not destroy their toxic qualities, it appears to 
set aside their specifically poisonous character. f On the other hand, 
though Brieger, in liumau cadavers, discovered ptomaines early in 
the period of decomposition, it was not until the seventh day that 
he was able to isolate a ptomaine having markedly poisonous qualities. 

Of the conditions which seem to favor the formation of poisonous 
ptomaines the limited access of air, or rather of oxygen, to the 
article in question is repeatedly referred to by authors. This has 
been remarked in connection with corpses that have been buried and 
subsequently disinterred for forensic purposes ; with poisonous 
sausages in which the peripheral portions, to which the air has freer 
access, are sometimes found not to be injurious ; with poisoning 
from canned meats as occasionally occurs ; and with the experiments 
of Prof. Vaughan with the two jars of milk, in one onh' of which 
was tyrotoxicon found, and that the one which had been closely 
corked. 

Regarding the more essential cause of the changes which give rise to 
the formation of the ptomaines, it is now pretty generalU' conceded 
that it must be referred to the activity of micro-organisms. In the 
science of the present day the bacteria play not only an imi)ortant 
part in the etiology of diseases, but we have come to recoguizo some- 
thing of their activity' in many of the other processes of life and of 
death. Back of the physiological activities of the plant or of the ani- 
mal and essential to tiiom, is the work of the microscopical world. 
Partly through these smallest of all organisms the soil is made fit for 
the plant, and the ammonia and other chemical compounds are changed 
into a form aRsimilal)le by the vegetable world. And hand in hand 
with the l)uilding up, tiiere goes on in the economy of nature the 
process of tearing down and lemoving the dead and effete material. 
As was first made clear to us by I'astour, the fermentation processes, 
as we see in the alcoholic, the acetic, tin; but} ric, and the ammonia fer- 
mentations, are rendered possible; only l)y the presence of specific 
micro-organisms. Dead organized matter, with the favoring condi- 

* IJrif^Kcr, UntorHUchuiigmi ucljur l'tori)uiii((. licrlin; 1880, page 64. 

t JIUHCiaan, Ktal-iineyclopaeclie tier KCHauiinten ituilkuuclc. Vol. XV, p. 6. 



VARIOUS SANITARY TOPICS. 171 

tions of temperature and moisture, is sure to go into rapid deeaj', 
and its preservation can only be accomplished by the exclusion of 
bacteria by hermetical sealing or by the addition of chemicals or 
other antiseptic agents which are inimical to the development of the 
l)acteria. As in the exercise of its function of growing and multi- 
plying, the yeast plant changes sugar into alcohol and carbonic acid, 
so in the decomposition of albuminoids, the functional activity of 
the bacteria, probably sometimes ])y building up the elements into 
new combinations, and sometimes by removing an element from old 
combinations, gives us new forms of matter. It is in this way and 
b}' these agencies that the basic substances which we call ptomaines 
are thought to arise ; and as the saccltaromyces vini by its vital 
activities produces a poison which puts an end to its life after a while, 
so it is quite sure that in the decomposition of the albuminoids each 
bacterial form puts an end to iis existence b}' drowning itself out in 
its own poisonous excretions. In coming to these conclusions we have 
been helped more by the chemist than by the bacteriologist. From a 
chemical point of view Brieger* has of late made some additions to 
our knowledge on this subject. He has not only shown the fact that 
in the process of decomposition a variety of ptomaines successively 
arise, but he has sought to determine the nature of the changes which 
are induced in culture-mediums by pure cultures of certain bacteria. 
From the culture of the Eberth bacillus of typhoid fever and also 
from the reputed bacterium of tetanus he succeeded in isolating a 
ptomaine in crystals, which, tried upon animals, showed toxic quali- 
ties. The ptomaine from the bacterium of tetanus when tested upon 
mice, frogs and guinea-pigs, caused tetanoid spasms both tonic and 
clonic which, after a time, ended in death. 

The term leucomaines has been applied by Gautier to alkaloids 
resembling the ptomaines, but which are found in living instead of 
in dead bodies. They are thought to be a necessary concomitant 
of the callular activity in the living organism. Some of the leuco- 
maines which have been isolated are found to be very poisonous. 

GARBAGE FURNACES. 

One of the questions which is always before all our villages and 
cities, and one which, when the}- have tried to do anything, has 
hitherto been an endless source of trouble to the authorities, is the 

*UiitcrschuDgeu ueber Ptouaiue. Berlin, 1886. 



172 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

disposal of the wastes which are a necessary accompaniment of oar 
domestic, mercantile and manufacturing activities. Even around 
the solitary farmhouse, or the isolated suburban residence, the 
proper disposal of the solid rubbish and wastes of various kinds 
causes a deal of trouble, and, unless a proper disposition is made 
of them, they become a nuisance, offensive to the senses and danger- 
ous to health. If garbage raav become a nuisance in these isolated 
homes, as we cannot help seeing in far too many instances, how 
many more times are the difficulty of disposal and the evil conse- 
quences of faulty disposal magnified when house is added to house 
and the village or citj' arises. In this case not only is the individual 
or the family a nuisance to itself, but every household is within the 
noxious circle which surrounds other households. There are, more- 
over, greater obstacles in the wa}' of each householder's officiating 
as his own scavenger. Under these circumstances it is necessar}'', 
in the sanitarian's mind, that individuals operate with each other to 
devise and to carry out some common plan of ridding themselves of 
the offensive materials which collect about their homes or places of 
business, or that the town or village act in its corporate capacity to 
do this work. 

Though this work is desirable, and, if healthfulness is to be 
attained, indispensable, it must be confessed that it has been pretty 
generally neglected. Some of the causes of this perhaps are to be 
sought in a hereditary deficienc}' of the sense of the sanitary fitness 
of things. Other causes for this neglect are not so far to seek, but 
are due to the want of some practicable and not too expensive 
method of disposing of or destroying the garbage. 

Of the several methods which have hitherto been in use, it may be 
said that none of them are free from serious objections. If the gar- 
bage is carried any considerable distance into the country its trans- 
portation is attended with considerable cost. If buried, it still often 
remains a nuisance by contaminating the air or polluting the water 
in the neigliborhood. If utilized in part as food for swine or cows, 
there is sometimes inflicted upon the community which sends it forth 
a retributive penalty in the shape of an unwholesome milk and meat 
supply. 

In the case of a sea-l)oard town, if it is sent seaward, the gar- 
bage may depart from the place of its origin never to return, but in 
large part it is strewn along otlier coasts. 

The great desideratum has seemed to be some method which would 
not require a costly transportation of the garbage, or necessitate 



VARIOUS SANITARY TOPICS. 173 

the defilement of our sea-shores, but which would radically and ulti- 
matel}' destroy it near the place where it is produced. 

Within the last few years, a new method of disposing of garbage 
has been written about and talked about, and, to a considerable ex- 
tent, put into operation and practically tested. It is the method of 
destroying or cremating garbage by means of furnaces specially con- 
structed for that purpose. Where these garbage furnaces have been 
put into use, there is a pretty uniform consensus of testimon}- as to 
their success. When rightly built, the}' have done their work satis- 
factorily, and generally at considerably less expense than had hith- 
erto been incurred in disp(.sing of the garbage otherwise. But little 
or no cost is incurred for fuel to run the furnace, as the garbage is 
dried more or less before it is burned, and is made to consume itself. 
The cost of labor in attending the furnace is not great, and generally 
there are no unpleasant odors given off in the process of burning. 

This method has not been much used in this country-, bur. in 
Europe, and particularly in England, it has beenextensivel}' employed. 
Dr. O. A. Horr, a member of this Board, who has latel}- returned 
from Europe, made special enquiry in regard to garbage cremation 
in England, and all he could learn convinced him that this system is 
a success in that countr}'. The garbage furnaces in many of their 
towns have been in operation many years, and, in conversation with 
the Health Officer of the City of London, he learned that there are 
now forty-five of the English towns which make use of this method 
of garbage destruction. 

In this country, as far as I know, the experiment of destroying 
garbage by means of a furnace constructed especially for that pur- 
pose was first tried on Governor's Island, New York Harbor. A 
description of this garbage-cremator was given in the Sanitar}- 
Engineer of August 13, 1885, by Lieutenant Reilly, at that time 
Acting Assistant Quartermaster, U. S. A., at that post, and through 
the courtesy of that journal we are permitted to produce here the 
communication and its accompanying illustrations. 

OfKICK of Post QUAUXERMASTEti. ■> 

Governor's Island, N. Y. H., July 29, 18S5. / 
Sir : I enclose a sketch, to scale, of the garbage furnace which is in use 
here, as it niaj' interest your readers. The garb.age, varying in daily 
quantity from ten to tliirtj' cubic feet, used to be buried, but the small 
extent of ground available for the purpose became so s.aturated that, in 
summer time, especially, the odor was distinctly perceptible and not 
agreeable. For this reason it was finally decided to burn the garb,ige, 



174 



STATE BOARD OF HEALTH — SPECIAL PAPERS. 




^£crfOA/ or/ //-/V^ /f.^. 







VARIOUS SANITARY TOPICS. 175 

and I made mnny unsuccessful attempts to get some information as to the 
proper construction of a furnace for tlie purpose. I finall}^ applied to you, 
and it was on information derived entirely from your valuable paper that 
the furnace now in successful operation wfls built. An experimental one, 
which gave excellent results, was first tried by obtaining an old brick 
oven so as to get something similar to "Fryer's Destructor," which was 
described in your paper. 

The one now in use consists essentially of a chamber. A, 4x5x3 feet, 
lined with fire brick and divided into three spaces by two gratings, B, 
composed of 3-4-inch round iron bars with inch openings between them, 
and the necessary doors, grate-bars (surface six square feet), and ash-pit. 
The gratings are for the purpose of supporting the garbage so the heat 
can get through and dry it, and to prevent it from stopping the draught 
or putting out the fire. 

Its operation was commenced by making a coal fire and putting the 
garbage in on the right side to dry ; the next day's garbage was put in on 
the left side, and the dry garbage was then raked over the fire. By 
placing the garbage on the right and left alternately, dry garbage is sup- 
plied and the fire kept constantly burning. 

The chimney, owing to its location, had to be built fifty feet high, 
although it was originally intended to have It only thirty feet, which 
would iiave given ample draught. The total cost was about S350. There 
is a slight, inoffensive odor from the chimney which is perceptible in cer- 
tain conditions of the atmosphere; it is very similar to that given off by 
burning letter paper. No fuel of any kind other than the garbage is used 
or needed, unless the fire is allowed to burn out, when, of course, some 
fuel is necessary to start the new fire. One man has charge, and after 
putting in the day's garbage generally limits his attention to raking dry 
garbage over the tire at noon and again at sunset. 

Very respectfully, 

H. I. Reilly. 

Further infornoation regarding this cremator, after its continued 

trial for a year and a half, is contained in the following letter, 

kindly written by Lieutenant Reilly in answer to enquiries sent from 

this office : 

FoKT Hamilton, N. Y. H.,\ 
20, Jan'y, 1887. J 

A. G. Young, M. D., Sect'y Board of Health, Augusta, Me. 

Dear Sir: Yours of the 15th was forwarded to me and was received 
yesterday. 

The garbage cremator was in successful and uninterrupted use, from 
the time it was first started until I left Governor's Island last August, and 
I believe still continues so. 

No repairs were made, nor were any necessary up to the time of ray 
departure; the only expense incurred for its operation is the value of the 



176 STATE BOARD OF HEALTH SPECIAL PAPERS. 

unskilled labor of one n)an, who puts in the garbage, rakes down the 
lire, and removes the ashes; the actual time required for this is less than 
four hours daily. 

The qnantitj- of garbage consumed is limited by the daily collections 
and is only sufficient to keep the fire going continuouslj'. I never had 
enough to test the capacity of the furnace ; if the draughts were opened, 
one day's dried garbage would not last an hour; and this was the amount 
collected from 2.50 to 300 inhabitants of the quarters on the Island. 

I found that after the garbage was subjected to the moderate heat of 
furnace, it lost 50 per cent of its bulk, and, in its dried state, made a very 
good fuel. 

The combustion of the garbage at your summer resorts seems to me to 
be a very simple problem ; it only requires an interior space sufficiently 
large to accommodate the garbage to be consumed; this space lined with 
fire brick, and divided so that the fresh garbage can be subjected to the 
action of the heat for sufficient time to dry it, and sufficient grate and 
flue surface to consume this, is all that is neces=ary. 

The ashfs and cinders make a very good fertilizer, which can be ex- 
posed to rain or sun without giving forth any perceptible odor. 

1 am sorry I did not have the necessary time while I was at Governor's 
Island to nuike any experiments as to the rate of combustion, say per 
cubic foot, so as to give you definite information on this point. 

Hoping that there may be some information in this that may be of use 
to you and regretting that there is so little, 

I am, very I'espectfully, 

H. I, Reilly, 

1st Lieut. ^ 5th Artillery. 

The garbage furnaces, to which reference has been made, are de- 
signed to dispose of only those waste substances which cannot be 
taken care of through a sewerage system. They need very little or 
no other fuel than what is contained in the garbage itself, after it 
has been dried in the furnace. Still a further extension of this rad- 
ical destruction of offensive matter by fire is the application of this 
system to the burning of night soil. When, with the other garbage, 
the contents of the privy vaults is included in the furnaces, the cost 
of destruction is increased, for fuel of some kind, other than the 
garbage itself, has to be supplied. 

A series of experiments in this direction, which were made last 
year by the health authorities of AVheeling, W. Va., were detailed 
in an interesting paper by Dr. George Baird, of that place, and read 
at the last meeting of the American Public Health Association, at 
Toronto, in October. The summary of the paper, as given in The 
Sanitarian, is as follows : 



VARIOUS SANITARY TOPICS. 177 

"The relative situations of Wheeling, W. Va., and Bellair, O., 
is such that the drinking water of the latter place is poHuted hy the 
night soil of tlie former, showing the folly of the claim that a run- 
ning stream of water will purify itself in a few score feet. Opposite 
the extreme southern limit of Wheeling, on the west side of the 
river, is the north limit of Bellair. The latter town takes its water 
supply fiom the river into which the former place pours its night 
soil. The consequence is that Bellair is made a hot-bed of disease. 
For the purpose of doing away with the evils caused in this wa}', 
the Wheeling Health Department, last spring, made a series of ex- 
periments in the destruction of night soil and garbage by fire, and' 
they claimed that, as a result, the}' had found a means of entirelv 
destroying these substances and their power to do evil. Two facts- 
about the burning of night soil impressed them. One was that the 
odor was not such a one as all thought it would be. It was some- 
thing akin to the smell of burned leather. Another was the 
intense heat required to burn it. The first experiments were 
made in a bench of five retorts, at the city gas works. The night 
soil was mixed with fifty per cent of fine slack, and three retorts- 
charged with this mixture. The other two retorts were charged, 
with a mixture of equal parts of night soil and ' breeze' (fine coke 
siftings). The retorts were charged at 11 P. ]M., and it was not? 
until seven o'clock next morning that the contents were reduced to- 
a fine, odorless powder. Another experiment of the same kind; 
showed that retorts were not the proper things for successful com- 
bustion, owing to the want of a full supply of oxygen. It was then, 
determined to find a furnace with a strong draft, capable of pro- 
ducing a greater heat than could be obtained in the retorts. The 
boiling furnace of a nail mill was then prepared for a third experiment. 

"After twenty-four hours' heating a charge of twenty- per cent fine 
slack, and eighty per cent night soil was made, and it was burned 
in one hour and twenty minutes. A second charge of 'breeze' and 
night soil was made, and it was burned in a little more than one 
hour. A third charge of night soil alone was made, and it was burned 
in about the same time as the first charge. Application was then made 
for the use of a Smith gas furnace, for the heating of steel slabs^ 
preparatory to being rolled into nail plate. This furnace is much 
larger than the boiling furnace, and capable of generating a more 
intense heat than any other furnace known. The use of one of these 

12 



178 STATE BOARD OF HEALTH SPECIAL PAPERS. 

furnaces was given. The result was as follows: A barrel of ordi- 
nary garbage, or slop, was bu-ned in four niinutes ; a barrel of 
butcliors' offal (bones and animal matter) was burned in seven min- 
utes ; a barrel of fluid night soil, thrown into tlie furnace with buck- 
ets, was almost instantly evaporated, and a barrel of solid faeces was 
burned in fifteen minutes. Convinced that this furnace had every 
requisite for fulfilling the design of destroying night soil and gar- 
bage, the Committee reported the result of the above experiments 
to the Council, and recommended the making of a contract for the 
building of such a furnace, capable of destroying daily sixt}' tons of 
night soil and garbage, and also for burning dead animals of all kinds 
which might die within the city limits, as well as the refuse matter 
from the butcher-shops. This furnace is to be constructed for using 
natural gas as a fuel. Of its success the writer maintains that there 
could be no doubt. The heating capacity of natural gas is more than 
four times greater than that of coal, which was used in destroying 
night soil in a boiling furnace in one and one-quarter hours. With 
artificial gas generated from fine slack, the night soil was burned in 
fifteen minutes. With natural gas better work could be done. 

"■Notwithstanding the great difficulty of destroying this substance 
by fire, there is in the use of natural gas, as a fuel, more risk of destroy- 
ing the furnace than of not entirely consuming the night soil. It 
must not be understood, the writer continued, that this furnace can 
only be used in cities and towns where natural gas has been introduced 
as a fuel. Mr. Smith has gas generators Iniilt with his furnace in cities 
wluMc there is no natural gas, and claims that he can produce a heat 
of greater intensity and witli more economy tiian by any other method 
■or from any other source outside of natural gas, and as cheap as 
natural gas can be su[)plied by a private company. The hue coal or 
slack is not the only substance from which artificial gas can be gen- 
erated. Tan-bark, peat, and many other substances can be used. 
Mr. Smith's faith in the success of the furnace is so strong that he 
has agreed with the Wheeling corporation to ask no compensa- 
tion until, by a series of successful experiments, he has shown its 
capacity to destroy all substances proper to be offered as tests of its 
powers. 

"In repl}' to a question, Dr. Reeves stated that the cost of the 
furnace does not exceed S2,60()." 

The furnace which was building by Mr. Smith has recently been 
completed, and I am under obligations to Dr. Baird for information 
received at an early date regarding the results of the preliminary 



VARIOUS SANITARY TOPICS. 179 

testing of the furnace. The first test was deemed very satisfactory, 
and consisted in the destruction of the carcass of a horse in one 
hour. A peck measure, it was said, would have held all that remained 
of the bones and from these the animal matter was completely burned 
out. An enclosed newspaper clipping gave the results of the second 
test, as follows : 

"The second test of the power of the Wheeling crematory furnace 
took place yesterday and was an unqualified success, fulh' sustain- 
ing the high opinions formed by M. V. Smith, its builder and inventor. 
The bad road prevented the securing of more than twentj- barrels 
of night soil, and this was almost entirely the contents of dry vaults, 
being mixed with ashes, cinders, cla}- and other debris. It was 
fully one o'clock before the work of charging the furnace with the 
contents of the barrels and a quantity of miscellaneous offal was 
begun, and nearly two o'clock before it was finished. 

''The gas was then turned on. and in a few moments all the vola- 
tile matter was decomposed by the intense heat and driven off in 
the form of vapor and gas, leaving the earth}' matters and cinders 
as a residuum. Much of this stuff, having alread}' been passed tiirough 
fire, would not burn, but the steady application of heat to the mass 
soon reduced it to the consistency of tar, it much resembling an 
impure article of glass or furnace slag, having about it no sign or 
symptom of impurit}'. 

'•The nature of the stuff used made the test very severe, but 
highly satisfactory. There was little or no smoke and no odor except 
from the stuff spilled on the outside from the imperfect mode of 
charging the hiriiace." 

Last year an appropriation was made by the city of Toronto, 
Canada, for the purpose of building several garbage furnaces, and 
Montical has a furnace for the destruction of night soil which has 
been in opeiation since the sununer of 1.S85. 

Pul)lic and municipal attention is turning to the favorable results 
which have accompanied garl)age cremation in England, and it is 
sate to predict that in the immediate future there will be a much 
larger number of examples in this country to which we can point, 
as illustrating this system of dealing with the garbage question. 
This method seems particularlv applicable to the needs of our sum- 
mer resorts, whether consisting of a sin::le hotel or of a considerable 
town, as in the case of Bar Harbor or Old Orchard, and, both in the 
interest of public health and as a matter of business, it would 
undoubtedly pay some of these places to examine this question. 



Third Annual Meeting of the National Confer- 
ence of State Boards of Health. 



BY E. C. JORDAN, C. E. 



As delegate to the National Conference of State Boards of 
Health, I beg leave to submit the following report of such parts of 
the proceedings as, it is thought, may be of public interest in our 
.State : 

The third annual meeting of the Conference was held in the par- 
lors of the Queen's Hotel, Toronto, Ont., October 4, 1886. The 
meeting was called to order by Dr. G. P. Conn, Secretary. The 
President, Dr J. N. McCormack, not being present, Dr. H. B. 
Baker, of Michigan, was chosen pro tern. 

After the minutes of the last meeting were read and accepted, Dr. 
William Oldright, chairman of the local sub-committee, was intro- 
duced and in a very happy manner welcomed the members to 
the cit3'. 

At this opening session, upon calling the roll of the States, there 
were delegates from twenty-one of the States who answered, and 
also from the District of Columbia, Dominion of Canada and the 
Provinces of Ontario, Quebec and Manitoba. 

The first paper presented to the Conference was "A Comparative 
View of Sanitary Laws, and what Changes are Needed in those 
of Maine," by the Secretary of the State Board of Health of Maine. 
In the absence of Dr. Young, it was read by 3'our delegate, and will 
be found in full in other pages of the second annual report. A 
brief discussion followed the reading of the paper and a committee 
consisting of Dr. A. G. Young, of Maine, Dr. H. B. Baker, of 
Michigan, and Dr. William Oldright, of Toronto, was appointed 
to report a codification of the health laws of the several States and 
Provinces at the next meeting of the Conference. (180) 



CONFERENCE OP STATE BOARDS OF HEALTH. 181 

The followino; resolutions were then taken up : 

From Fennsi/lvania — 

''Whiit precautions should be taken to prevent the bodies of 
deceased persons from becoming a source of injury to the public 
health during transportation on lines of public travel?" 

From Michigan — 

''1. Resolved, That the bodies of persons dead from the following- 
named diseases should not be transported outside the jurisdiction of 
the health authorities in which the deaths occur : Diphtheria, scar- 
let fever, small-pox, cholera, yellow {qxqy and typhus fever. 

"2. Resolved, That persons sick with diphtheria, scarlet fever, 
small-pox, cholera, yellow fever, typhus fever, measles or whooping 
cough should not I)e transported outside the jurisdiction of the health 
authorities in which the sickness occurs. 

"3. Resolved, That the bodies of persons dead from diseases 
other than those mentioned in Resolution Ko. 1 should not be tians- 
ported except by the permission of the health officer of the locality 
in which the deaths occur ; and in case of communicable diseases 
other than tliose named in Resolution No. 1, notice should be given 
to, and whenever practicable permission should be received from, 
the health officer of the locality to which it is desired to take the 
body. 

"4. Resolved, That a permit for the removal of a dead body should 
be given only on assurance of its having been properly embalmed, 
suitably prepared, by being surrounded with disinfectants, or 
enclosed in a hermeticall}' sealed metallic case." 

Tlie following are extracts from the remarks of Dr. Benj. Lee, 
Secretary of the State Board of Health of Pennsylvania : 

"Very soon after the establishment of our State Board of Health, 
I was waited ui)on by a lawyer from one of the towns in the 
interior of the State to know whether the board would sanction the 
exhumation and removal of the body of a man who had died of 
small-pox. The local board of health had forbidden the exhuma- 
tion, but the widow was extremely anxious for the removal, and he 
had come ou her l)i'half to inquire whctlier we could not reverse their 
decision. I replied that the object of the State board in its relation 
to local boards would always be to uphold them in all their ctforts to 
protect the public against infectious diseases, and not to weaken 
their authority, and that in this instance we should certainly deem 
it our duty to sustain their ruling. I subsequently learned the his- 



182 STATE BOARD OF HEALTH SPECIAL PAPERS. 

torv of this case and felt happy in having decided as I had done. It 
appeared that the deceased was a lawyer of some prominence who 
was thoroughly imbued with the anti-vaccination heresy. lu public 
and in private, on the street, in the social circle and through the 
public press, all his efforts were concentrated, both by denunciation 
and ridicule, to the end of discouraging his fellow citizens from 
subjecting themselves or their children to this operation. Finally he 
■was taken sick and his physician announced to him that he had 
small-pox. The case proved to be confluent, of the worst type, 
and he died in great agony. Fortunately his reason was spared him 
long euough to enable him to understand and repent of his long 
course of crime. Who knows how many lives he may have indirectly 
sacrificed by his wicked presumption before he committed suicide 
himself? And it was this horribly infected body of a man who had 
spent his best energies in exposing his fellow beings to infection, 
which his widow now wished, in order to gratify a mere sickh' sen- 
timentality, to render a new center of contagion, and thus add still 
other victims to his list. I was thus deeplv impressed with the 
importance of placing this matter under strict control ; but I felt 
that unless other States were willing to co-operate, but little could 
be accomplished for the protection of the people of my own. It was 
with this object in view that I requested the Secretary of the Confer- 
ence to give the subject a place on the programme for discussion. 
"The plan authorized by the Board of Health of the city of Phil- 
adelphia commends itself at once as being eti'ective and inexpensive. 
The coffin, of whatever kind, unless it be an absolutely secure 
metallic coffin or casket, is placed in a tight wooden box lined with 
felt, which has been recently smeared with pitch. The cover of this 
box is provided with a flange near the edge which sits in a groove 
on the edges of the box. This groove contains a strip of India 
rubber. When the cover is screwed tightly down upon this rubber 
strip the box is sealed as hermetically as a preserve jar. The object 
in framing all regulations of this kind should be to protect the pub- 
lic health with the least possible interference with private rights and 
the least possible involvement of expense. I cannot but regard the 
absolute i)rohil)ition of the disinterment or transportation of the 
])odi<;s of those who have died of the first four named intensely infec- 
tious and malignant diseasos as (Muinently wise. When I remem- 
l)er that 1 have held in my hand a grain of wheat taken from an 
Egyptian mummy, three thousand years old, and that a similar grain 



CONFERENCE OF STATE BOARDS OF HEALTH. 183 

to that has been planted and has germinated, and when I remember 
that we are still in ignorance as to the lengtli of time that the gerra 
of any of these infections may retain its vilaliU', I feel that it is not 
wise to run the risli of saving these germs in half a dozen dilFerent 
States for the sake of gratifying a sentiment which is, after all. I)ut 
a survival of the pagan worship of the dead. The importance of 
uniformit}' in such regulations can not for a moment be questioned. 
When all the States have adopted a uniform system, and a uniform 
permit, the transportation of a bodv from State to State, if it lias 
been properly prepared at the place of death for such transportation, 
will take place with perfect ease and all possil)le celerity, all the 
vexations, delays and expensive details which are now so apt to 
occur at the terminus of ever}- road and the border of every State 
being done awaj' with. And at the same time, it being tliorougiily 
understood that certain requirements must be met, proper precau- 
tions will be taken at the point of departure, so that there will be no 
risk of bodies arriving, as they have arrived in the past in the city 
of Philadelphia, coming from the extreme southern confines of our 
countr}- in a state of such advanced decomposition that the lid of 
the colRn or box has been burst open by the expansion of the gases 
of decomposition. 

"In order to bring the subject properly before the Conferenrc, I 
would move the adoption of the rules proposed by the delegaiiou 
from Michigan, as the}- appear on the programme." 

After considerable discussion and the expression of some adverse 
views as to the expediency of adopting the resolutions as intruduced, 
the whole subject was referred to a committee consisting of Dr. 
Benjamin Lee, of Pennsylvania, Dr. Cliarles H. Fisher, of Rhode 
Island, and Dr. Samuel W. Abbott, of Massachusetts. 

The Secretary read the following subjects and points of discussion 
presented by the State Board of Health of Missouri : 

''1. How shall County Boards of Health be organized, managed 
and directed, in order to secure to the State Board, if such exists, 
the most efficient help and co-operation in general sanitary work, 
the reporting and proper registration of vital and mortuary statistics, 
and the enforcement of laws regulating medical practice in States 
where such enactments exist?" 

Dr. Chas. N. Hewitt, Secretary State Board of Health of ]Minne- 
8ota, stated that a county board of health stands in the same rela- 
tion to the State Board that the family does to society. He said 



184 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

the}- had 1,050 efficiently organized local boards of health in Min- 
nesota. The local boards have charge of the sanitary inspection of 
their districts, both in respect to men and animals. He explained 
the perfect system of communication between the State and local 
boards l)y stating that small-pox appeared in a distant township and 
within twent\'-four hours he had a list of every man, woman and 
child who had been exposed, and within fort3'-eight hours after he 
received the first telegram every one was vaccinated or quarantined 
and the disease did not go beyond the famil}' in which it first 
appeared. The work was done by two local health officers, and the 
expense to the State was $10.50. Contagious diseases of animals 
are controlled in the same prompt manner. A little treatise upon 
glanders was distributed to the local boards of health. He found 
that in proportion to the efficiency of the local board organization, 
with the co-operation of the State Board, was the efficient sanitary 
work of the State performed. Local boards should understand that 
they stand shoulder to shoulder. When the local officers have any 
trouble, then it becomes necessary for him to visit the locality, and 
the people are so well satisfied with the rulings of the State Board, 
that its decisions have never been disputed. He thought that the 
organization of local boards lay at the foundation of all sanitary 
work. Local boards look to the State Board for assistance. He 
enlisted the services of young physicians and found many competent 
men who liked the work. In the matter of expenses incurred, if the 
local board cannot pa}', the State Board does ; but the local boards 
have to pay if they can. The expenses incurred by the health offi- 
cers in an epidemic in Minnesota is so small that the people do not 
realize it. The ap[)ropriation for the year for the State Board of 
Health is i|>5,000, $2,500 of which is the salary of the Secretary 
and the balance used at the discretion of the board. They had 
organized the laboratory, and young men from the State University 
were glad to work in it for the experience it affords. One student 
obtained a scholarship in consequence of the advantages of his 
laboratory work. 

Dr. Lee said he had listened to Dr. Hewitt's remarks with much 
interest. There had been in Pennsylvania a very strong pressure 
Ijrought to bear for the establishment of county boards. He was 
glad to have the benefit of Dr. Hewitt's ex[)eriencc. There are no 
local boards outside of the incorporated cities and boroughs. 



CONFERENCE OF STATE BOARDS OF HEALTH. 185 

Dr. OUlright said he would like to hear from Dr. Hewitt in rej^ard 
to nuisances. In these matters they needed men who were trained 
for the work, but boards of supervisors were not elected with special 
reference to their qualification as health officers. In times of epi- 
demics the financial interests of the town are in danger, and the 
authorities are very glad to co-operate with the board. 

Dr. Hewitt stated that none of the supervisors professed to be 
sanitary men, but it was surprising to see how much they knew 
about the work, and some of their best inspections had been made 
by these men. 

Dr. J. N. McCormack, Secretary State Board of Health of Ken- 
tucky, said they had no township supervisors in his State. They 
had great difficulty in organizing county boards of health in any 
considerable number of counties, but that some five or six years ago 
the law was amended so as to leave the appointment of county 
boards of health to the State Board. He could not go so far as Dr. 
Hewitt did in speaking of the general efficiency of the local boards. 
He found no difficulty in times of epidemics, but in typhoid fever 
and diphtheria, which cause a far greater mortality, it was difficult 
to get them to take any very active steps. Another difficulty was 
in the collection of facts. It was to be hoped that they might be 
able by modern methods of sanitation to remove the causes of these 
diseases. In this they had not been able to get the active co-opera- 
tion of the county boards of health. In very many instances they 
had secured efficient co-operation, and latterly, since the election of 
new health officers, the State Board had been able to get a fair san- 
itary survey of most of the counties of Kentucky, and he felt very 
mu(;h encouraged with the condition of health aflfairs in the State. 

Dr. C. A. Lindsley, Secretary of the State Board of Health of 
Connecticut, said he was much interested in the report of Dr. 
Hewitt. In Connecticut, they were, perhaps, far behind the Western 
States in the matter of sanitary work, and chiefly for reasons which 
had been mentioned, and the aid and assistance which the}' ought 
to have from the local boards of health. In Connecticut there was 
a nominal board of health in ever}* town, consisting of the select- 
men and the justices of the peace. A provision was made which 
authorized them to add such physician as the}' might choose, so 
that the board properly consists at present of the selectmen, justices 
of the peace, and such physician as they may elect. It was pro- 
vided that this body may delegate their duty and powers to a 



186 STATE BOAED OF HEALTH — SPECIAL PAPERS. 

committee, and he considered that a very wise provision. At the 
last session of the LegisLiture a provision was made that on the 
"Wednesday following the first Monday- in October, these boards of 
health shall organize. They were satisfied with the honor of being 
called the board of health, but in nine cases out of ten, except in an 
epidemic of small-pox, they have never taken any action as a board 
of heath ; now they are required to organize and elect officers. In 
Minnesota and other Stales there seemed to be mandatory power 
lodged in the State Board which his board knew nothing of. They 
can not require anything of anybody ; they simply give advice. If 
it were possible to have more power he thought it might be expended 
with advantage, but he thought they had made a gain in regard to 
organization and in securing reports from local boards of health. 

Dr. J. F. Hibberd, of Indiana, inquired of Dr. Hewitt whether 
he had reason to believe that there had been outbreaks of disease of 
which he had gained no knowledge. AVhether the local boards gave 
their attention to cases of typhoid fever and diphtheria? 

Dr. Hewitt said that typhoid fever sometimes prevailed of which 
the}- did not hear. The report of infectious diseases in his State is 
conipulsor}'. Some communities would not call for a physician, and 
they had to compel the poorer classes to receive the attention of the 
physician. The}' sometimes absolutely refused medical attendance. 
Diphtheria was one of the most difficult diseases to corral. He said 
there were many outbreaks of which they never heard, but in the 
majorit}- of cases they were glad of the help of the State Board. 
He said: "We preach and pra}' and exhort; we keep up the talk 
and are making headwa3\ I tell you sanitary workers have got to 
work with the brake on. I have to run it witii the brake on, and 
expect to wear the brake out." They distribute information in the 
form of circulars and publish a paper devoted entirely to the interests 
of sanitation. 

Dr. Hunt, of New Jersey, said that in his State they were able to 
accomplish a great deal with the aid of the local boards. In addition 
to the local boards the}' appoint inspectors. 

In the afternoon the Conference met according to adjournment. 

The following propositions from Kentucky : 

"What have been the actual practical results secured, outside of 
large cities and towns, in preventing the spread of scarlet fever, 
measles, diphtheria and typhoid fever? and how is the co-operation 



CONFERENCE OF STATE BOARDS OF HEALTH. 187 

of the medical profession and general public best secured in such 
work ?" 

The discussion of the three questions embraced therein was opened 
b}' Henry B. Baker, M. D., Secretar}- of the Michigan State Board 
of Health. 

"The Michigan vState Board of Health was established in 1873. 
Late in that year the Board issued a circular to physicians, stating 
the duties of physicians and others under the law in dealing with 
'small-pox, and other diseases dangerous to the public health ;' also 
showing the relative danger to the public, from the various commu- 
nicable diseases. The circular showed that scarlet fever caused 
more deaths by far than small-pox, and it was urged that if scarlet 
fever was properly resti'icted, the deaths from this disease might be 
greatly lessened. The circulars were distributed to the physicians 
throughout the State. From that time forward, scarlet fever in 
Michigan has been treated by the State Board of Health as a dan- 
gerous communicable disease, and at present isolation and disinfection 
are generally enforced by local boards." 

Tables were exhibited which showed that there had been in Mich- 
igan a decided lowering of the death-rates from small-pox and scarlet 
fever, since the State Boaid adopted the practice of distributing its 
preventive circulars for these diseases. The tables made a compar- 
ison of the number of deaths from these diseases, for a series of 
years, before and since the distribution of these documents was 
bejriin. 

The following subject was considered : 

"Investigation of the causes of disease. How can State boards of 
health secure the best results?" 

Dr. Fisher opened the discussion by saying that the question to 
be considered by the Conference was the advisabilit\' of planning 
some method of utilizing the great mass of material that might be 
obtained through the physi(tians of the various States. He thought 
the subject should be taken into consideration by a committee dur- 
ing the year and a report made at the next meeting of the Confer- 
ence. If it seemed advisable, they might report plans and methods 
of procedure, even, perhaps, to the circulars of enquiry, the ques- 
tions to be submitted and the manner of recording the facts. He 
thought that by distiilniting proper circulars and blanks to the great 
mass of physicians they would be able to return a great deal of val- 
ualile iuformalion upon some one line of inquiry. At any rate, it 



188 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

would be of advantage to the physicians in inducing them to observe 
and record their observations, and b}' this means there would be an 
advance in the qualifications of those engaged in the work. From 
the circulars distributed facts could be recorded and returned to the 
board, and the facts thus presented could be classified and some 
really logical conclusions might be drawn therefrom. He desired 
the opinion of the Ccwiference on this subject. 

At the evening session, after the discussion and disposal of other 
subjects, the following was taken up : 

"Inter-state notification in regard to infectious diseases and inter- 
state co-operation in regard to inspections, and other work for the 
prevention of the same." 

Dr. Bryce, of Ontario, read a paper upon this subject. 

At the afternoon session, on the second day, the following resolu- 
tions were offered and adopted : 

"Whereas, It is necessar}' for the protection and preservation of 
the public health that prompt information should be given of the ex- 
istence of cholera, yellow fever and small-pox ; be it 

"1. Resolved, That it is the sense of the National Conference of 
State Boards of Health that it is the dut}' of each State, provincial 
and local board of health in anj' locality in which said diseases may 
at anj' time occur, to furnish immediately information of the exist- 
ence of such diseases to boards of health of neighboring and pro- 
vincial States, and to the local board in such States as have no State 
board. 

"2. Resolved, That upon rumor or report of the existence of 
pestilential diseases, and positive, definite information thereon not 
being obtainable from the proper health authorities, this Conference 
recommends that the health officials of oue State shall be privileged 
and justified to go into another State, for the purpose of investigating 
and establishing the truth or falsity of such reports. 

"3. Resolved, That, whenever practicable, the investigations made 
under the preceding section sliall be done with the co-operation of 
the Slate or local health autiiorities. 

"4. Resolved, That any case which presents symptoms seriously 
suspicious of one of tiie aforenamed diseases shall be treated as sus- 
picious, and reported as provided f(jr in cases announced as actual. 

"5. Resolved, Tiiat an}' case resi)ecting which n^putahle and ex- 
perienced physicians disagree as to whetiier the disease is or is not 
pestilential shall be reported as suspicious. 



CONFERENCE OF STATE BOARDS OF HEALTH. 189 

"6. Resolved, That any case respecting which efforts are made to 
conceal its existence, full history and true nature shall be deemed 
suspicious, and so acted upon. 

"7. Resolved, That in accordance with the provisions of the fore- 
going resolutions, the Boards of Health of the United States and 
Canada represented at this Conference do pledge themselves to an 
interchange of information as herein provided.'' 

At the morning session of the second da}', the first subject taken 
up was ''The Plumbing of the New Capitol of Indiana." Upon this 
subject the following paper was read b}' Dr. Metcalf : 

Mr. Chairman and Gentlemen: — The subject to whicli I desire to call 
your attention is one which may not be of much moment to you individu- 
ally or collectively, but it is one of paramount importance to the board 
which I represent and the people ot the State. This importance is height- 
ened by the f;xct that it will, in all probability, be the subject of legislative 
investigation. If the positions we take are correct we ask your approval. 
If otherwise, we wish an expression t» that effect. 

There is now im process of construction and nearing completion, a Capi- 
tol building at Indianapolis, Indiana, which in many respects will be a 
credit to its projectors and tax-payers. 

This structure, as provided by law, is under the supervision of four com- 
missioners, of which the Governor is a member ex-officio. 

They began the erection of this building in 1877, some four j^ears prior 
to the organization of the State Board of Health. Kumors of defective 
plumbing and house drainage were afloat, and charges having been made 
to the same effect, at a meeting of the county health officers held at 
Indianapolis, February IS. 188G, Dr. J. F. Ilibberd, health officer for 
Wayne County, introduced the following resolution, which was unani- 
mously adopted : 

'■'■ Eesolved, That it is the sense of this convention that the Board of 
Health should institute such inquiry as shall determine with certainty 
whetlier or not there is anything defective in the sanitarj' arrangements 
of the JSlate House now under construction, and if anything defective be 
found in the ventilation, phuubing and drainage of the building or grounds, 
advise the State House Commissioners of the nature, extent and conse- 
quences of the defect, and what should be done to remedj' it." 

In conformity with this resolution, the Board of Health directed its Sec- 
retary to make an investigation of the matters referred to and report to 
the board. 

In obedience to this instruction, investigations were made from time to 
time, which resulted in revealing what we consider serious defects, which 
are as follows : 

First — A brick sewer, four feet in diameter, which is a part of the city's 
sewerage system, passes beneath the building. 



190 STATE BOAED OF HEALTH SPECIAL PAPERS. 

Second — Earthenware drain pipes with which the waste pipes from 
urinals and wash-stands connect, and also the soil pipes from the water 
closets, enter the sewer beneath the building. These pipes are buried 
beneath the basement floor and are inaccessible. 

Third — In the cellar, iron waste pipes enter earthenware pipes, the joints 
of whicli are made witli liydraulic cement. 

Fojtrth — A soil pipe on the first floor vents into a brick flue which opens 
into the attic. 

Fifth — At the north end of the building a soil pipe vents into the main 
chimne\-. 

Sixth — The soil pipes are Ave inches in diameter, and their branches four 
inches. 

Seventh — The waste pipes from urinals are four inches in diameter, and 
can not be thoroughly flushed by means ordinarily used. 

Eighth — Xo provision has been made for venting the traps to urinals 
and wash stands. 

Ninth — The soil pipes are not provided with fresh air inlets. 

We pointed out these defects in a communication addressed to the com- 
missioners April 23. 1S86, stating that in our judgment, unless these de- 
fects were remedied, the building in the near future would become disease 
breeding and endanger the liealth and lives of Its occupants. 

We object to the sewer because it is a part of the city's sewerage sys- 
tem, draining twenty squares before passing beneath the building. We 
maintain that the passage of a sewer beneath a building that is to be 
occupied b}" human beings is nnsanitary, and not in keeping with modern 
sanitnrj' teachings. 

The commissioners, in a reply dated May 20, 1886, defending the sys- 
tem of plumbing and hous*? drainage which they have adopted, embody a 
letter written by one Levi K. Green, whom they had employed to examine 
the work and report the result of his investigations. 

They say that this gentleman has a national reputation as a sanitary 
engineer, and that he has made plans and specifications for plumbing 
State houses, hospitals, penal institutions and hotels in various parts of 
the country. 

This sanitarian approves of a sewer passing beneath a building that is 
to be occupied by human beings, and particularly approves of the one 
that runs under our Capitol building, as he says, because "it is built of 
brick laid in cement and lined with cement," and tliat the '• basement floor 
is made of concrete or broken stone laid in cement." This design, in his 
Judgment, "will be altogether satisfactory and successful, and will never 
be the cause of any evil effects from a sanitary point of view." 

He also ventures the opinion "that if the State Board of Health is 
assigned quarters in the basement of the building, and are permitted to 
Jive until they are Injured by the gas tliorefroni they will die a good old 
age." 

In contradiction I will say that the sewer is not cement lined. The 
sewer and drains of the building are not provided with any means of 



CONFERENCE OF STATE BOARDS OF HEALTH. 191 

ventilation, and a standard authority says " unventilated sewers are far 
more dangerous than steam en<^ines without safety valves." 

Xeithor is it provided with means for llusliiiig except by rain falls which 
occur in tlie sprinj^. siiininer and fall, and flushing in this way can not be 
thoroughly acconipli>hed. 

If this sewer or house drain (which it becomes as soon as it passes be- 
neath the building, as it receives all the sewage of the building within the 
foundation walls) will not be flushed only as the rain may fall semi-annu- 
ally as above stated (and that is what the city engineer says in a letter 
to the commissioners) what will be the result? Simplj' this, that the ex- 
crement and other filth that is deposited in it during the winter seasoa 
nuist lie there to rot. decompose, generate sewer gas and breed disease 
germs to enter the building through the unventilated house drain and 
opening which may occur in the same. 

This engineer with a " national reputation"' (?) says that the basement 
floor is made of ''broken stone laid in cement," but at the same time he 
fails to mention the fact that many apertures have been made in it for the 
passage of soil and other drain pipes, thereby leaving convenient breath- 
ing places for the foul sewer. 

We will state, without fear of successful contradiction, that house 
drains to he used within a building should never be made of earthenware, 
cement or brick; and that the onl}^ material from which such drains 
should be constructed is iron. In support of this position, we will quote 
from standard authorities on sanitary engineoring and also part of section 
four (4) of an ordinance for the regulation of plumbing now in force in 
the city of Boston, the home of Mr. Green. It is as follows: "Drain 
and soil i)ipes through which water and sewage is used and carried shall 
be of iron when within a building, and for a distance of not less than five 
feet outside of the foundation wall thereof. They shall be sound, free 
from holes and other defects." 

William Paul Gerhard, Chief Engineer of Philadelphia, a mtMuber of 
the American Public Health .Association, in a work on house drainage and 
plumbing, says: "Fortunately, however, we can with petect safety run 
the drains across the basement floor of a dwelling provided we choose the 
only safe material, i. e., heavy iron pipe.''' 

Baldwin Latham, Past President of the Society of Engineers, London, 
England, in his work on sewerage and house drainage, says: "It is iui- 
perative that all sewers and drains should, throughout their entire length, 
be constructed so as to be pefectly impermeable," also that all ventilating 
pipes and drains should, as far as practicable, be kept out of the interior 
of a house and should be so arranged as to be easily examined at any time. 

James C. Bayles, Editor of " The Iron Age and Metal Worker," in his 
work on house drainage and water service, says: •' I have never seen a 
house drain built of stone, brick or wood, and rarely one built of earthen 
pipes with cement joints, which I should he willing to live over. Stone 
drains having rough inside surfaces can not be effectually flushed, and 
become coated throughout with foul deposits, offensive and dangerous in 



192 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

their rapid (Iccomposition. Brick drains as usually built have this objec- 
tion. to;;otlier with the liability of all but exceptionally i^ood bricks to 
disintegrate when buried and kept constantly wet. Even when highly 
vitrilied and laid with hydraulic cement, their rough surfaces and per- 
viousness of their joints to water are objections which should exclude 
theni from use for this purpose. Earthen pipes, even xchen icell gla.ved, can 
not be depended upon ichen laid in cellars, for the reason that the best cement 
joints are pervious to xcater, which carries xcith it organic matter to lodge and 
decompose in the pores of the pipe and its joints ;'' also that " iron is so much 
better than any substitute yet found for it, that it should, 1 think, always 
be exclusively used in the drainage of city houses."' 

Waring, Ilelyer and Davis, recognized authorities on house drainage 
and plnmbing, state unequivocally that all sewage shonld be carried out- 
side the building in iron pipes. 

The Sanitarij Engineer, published in N"ew York and London, and exten- 
sively read in the United States, in its issue of Januarj'- 28, ISSG, says: 
"A brick sewer in a building is out of place. It is a relic of an ignorant 
age in matters of house drainage and sewerage." 

The Sanitary News, in its issue of May 29, 1886, in spoaking of this 
sewer, says : '' It is shown that in addition to receiving the sewage of the 
State House, this sewer drains twenty squares of land, and is in fact a 
portion of the regular system of the city's sewerage, a fact which makes 
its position under a great building all the more reprehensible.'' 

The system of house drainage and plumbing adopted by the Govern- 
inent engineers is probablj'^ the latest and most improved, and they do not 
use brick sewers or earthen drain pipes in buiklings. In the post office of 
our city they abandoned the brick sewer formerly in use and substituted 
iron pipe. 

The engines that are to be used in running the machinery of the build- 
ing (such as ventilating fans, elevators, etc.) are to be exhausted into the 
sewer. This will cause sudden changes in the temperature of the air, 
producing unequal air pressure in the drain, which will seek relief at the 
points most easily forced, which points will be tlie water-sealed traps and 
any defects existing in the house drains. The same effects will be pro- 
duced by tile sudden Hushing of the sewer by a heavy rainfall. 

Another objection which our Board has to the system of plumbing and 
house draining employed, is that in the cellar, iron waste-pipes from urinals 
and wash-stands enter earthenware pipes, the joints of which are made 
with cement. The; change of temperature, or the alternate passage of hot 
and cold water through the pipes, will produce sufhcient contraction and 
expansion of the iron to break the seal and render the joints d(*fe(!tive. 

The rejjly of the commissioners contains a report submitted to them by 
the architect and 8ui)erintendent of the building, in which they say "the 
]dunibing has been arranged In accordance with the cardinal require- 
ments of perfect house drainage; cast-iron pipes for urinals, four inches 
in diameter, enter vitrified stoneware i)ipes. eighteen to twenty inches 
below the basement lloor line. The temperature at this level is constant, 
and in no case will expansion or contraction of a four-inch cast-iron pipe 



CONFERENCE OF STATE BOARDS OF HEALTH. 193 

cause a leak at this point." Tliis stiitenieiit that the connections are 
buried beneatii the basement lloor line is not true. The facts are, the 
connections are above the grade level, where they are liable to be broken 
at any time by havin<5 rubbish thrown against tlieni, and even if they 
were buried at the depth mentioned, we hold tiiat it is not admissible. 

These gentlemen admit that the earthenware pipes are buried from 
eighteen to twenty inches beneath the basement lloor line, and claim this 
to be in accordance with the ^'cardinal requirements of perfect house 
drainage." 

We find that leading authors on sanitary engineering lay down princi- 
ples diametrically opposed to the plan they praise so highly. Sanitary 
engineers with experience say "the best course of drain in the house is 
along the ceiling of the cellar, or along the foundation walls."' In other 
words, whenever practicable, the drain should be kept in sight in order to 
enable anybody to detect a leaky joint at occasional inspections. 

Circumstances sometimes '"make it necessary to lay the drain pipes be- 
low the cellar floor. In such cases it may be laid with proper fall in a 
trench, the sides of which are walled with brick work, and the base of 
which should consist of a layer of from four to six inches of concrete, 
thorougiily rammed and properly graded. The trench should be made 
accessible by closing it with covers of iron or wood. In no case should a 
drain that is below the, cellar floor be left inaccessible."' Tiie drains in the 
Indiana State House are not laid in accordance with the above, but on the 
contrary are laid in a crooked and irregular manner, with brick walls fre- 
quently built across them. 

No attention has been given to sanitary methods, either in laying the 
pipes or making the joints, as in many instances the cement has been 
simply plastered around the edges of the hubs and has cracked and fallen 
oflf. It is admitted by the commissioners, architect and superintendent 
that a soil pipe on the first floor vents into a brick flue, and maintained that 
this is in keeping with the latest and most improved methods employed- 
by sanitary engineers. 

We hold that this is not admissible and in no instance should ji brick 
flse or chimney be used as a ventilator for soil or waste pipes, on account 
of the liability of the noxious gases arising from the pipes permeating 
their walls and contaminating the atmosphere of the rooms. Rules for 
regulating plumbing, as far as we have been able to examine them, require 
that "sewer, soil and waste pipe ventilators shall not be constructed of 
brick, sheet metal or earthenware, and chimney flues shall not be used as 
such ventilators.'" 

We have objected to the five-inch soil pipes used because we believe 
that four-inch pipes are sufficiently large for a building with any number 
of water closets. The smaller pipes can be more thoroughly' flushed and 
do the work of larger ones. We object to the four-inch urinal waste pipes 
on account of their size, believing that half the size is large enough. 

13 



194 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

No provision lias been made for venting the traps to urinals and wash- 
stands. We claim that it is as essential that thej'^ shonld be vented as the 
traps to the water-closets, because they are us liable to become unsealed 
from sj-phonage, and if at any time this occurs the unsealed traps will 
allow a free escape of foul air in the waste-pipes. 

The commissioners saj' "all soil and waste-pipes are trapped at the bot- 
tom ; fresh air inlets are not provided for, as it is not believed best to do 
so under existing circumstances. In this latitude cold-air inlets would 
freeze the traps in the winter time." In the plumbing in the public build- 
ing at Indianapolis the government evidentij' has no fear of such an acci- 
dent, as fresh-air inlets are used. 

■yVe are reliably informed that the pure-air inlet is used in all of the best 
plumbing done in Boston, New York and Philadelphia, in which cities 
the winters are more severe than in the capital of Indiana. 

Wm. Paul Gerhard, in his work on house drainage and sanitary plumb- 
ing, says: "Fresh-air inlets are no less important than the extension of 
the soil pipes through the roof." In order to effect a constant movement 
and change of air in the pipes, two openings are required, an outlet and 
an inlet. The extension of the soil pipe through the roof provides only 
an escape for the foul air generated in the soil and waste pipes through 
the decomposition of foul organic matter clinging to the interior and 
lodging in traps under water-closets and fixtures. But in order to oxidize 
and render harmless this organic matter undergoing putrefaction within 
the pipes, a constant introduction of fresh air from the outside atmos- 
phere is necessarj'. There is a second and almost equally important 
reason for providing a fresh-air inlet whenever the third requirement, the 
'trapping of the drain, has been complied with. 

If a water closet is used or a pail emptied into a slop sink, the water 
disciiarged into the soil pipes acts like a piston, and carries the air on its 
course downward with it by friction. Thus the descending water drives 
the air before it, and out through the fresh air pipe. If this had not been 
provided it would very likely force the nearest traps, which are under the 
fixtures, and send a pulf of sewer gas into the rooms. 

We miglit quote from the works of Waring, llelyer and others in sup- 
port of the fresh-air inlet, but we do not d(!(!m it necessary. 

In conclusion, I desire to propound the following interrogatories: 
First. — Should the passage of a sewer under a building for human habi- 
tation be approvcc^y 

Second. — Should earthenware drain pipes be used within the foundation 
-walls of a building for tin; purpose of conveying sewageV 

Third. — Should iron waste; pip((s from urinals and vvashstands coimect 
■with earthen i)i|)eR within a IxulilingV 

Fourth. — Is the venting of soil pipes into brick (lues and chimneys ad- 
missible;' 

Fifth. — Is it not as necessary for traps to urinals and washstands to be 
vented as those of waU'.r closets? 

Sixth. — Should soil pipes be provided with fresh-air inlets V 



CONFERENCE OF STATE BOARDS OF HEALTH. 195 

Seventh. — Should the sewage of a building be deposited in the sewer 
within its foundation walls? 

I have asked these questions for the purpose of obtaining an expression 
from you, as these are the points on which our board and the commis- 
sioners have joined issue. 

A committee consisting of E. C. Jordan, C. E., of Maine; Dr. 
Wm. Canniff, Canada ; and Dr. G. B. Thornton, Tennessee, was ap- 
pointed to report upon the subject of the paper, and at the session 
on the fourth day E. C. Jordan, C. E., presented the following re- 
port : 

The committee to whom the interrogatories from the State Board of 
Healtii of Indiana in relation to tlie plumbing of their State House were 
referred, beg leave to report as follows : 

Your committee would state that it feels it unnecessary to answer 
the questioue! categorically. There are certain principles in house plumb- 
ing tliat we believe to be upon a solid basis and dangerous to depart 
from. The foremost of tiiem is that in the removal of the sewage, it shall 
be done through the medium of heavj' iron pipes proportioned to the work 
to be done, starting from a point at least live (Jy) feet exterior to the walls 
of the house, and extending from that point through the house and out of 
the top to a height determined by surrounding circumstances. Its course 
should be as direct as possible, and its position where its inspection would 
at all times be a matter of observation; in other words, as much in sight 
as possible. 

The que.^tion of any trap upon the outfall may be debatable, but your 
committee think it desirable and especially so from the fact that certain 
advantages claimed for its absence are much more fully realized by the 
fresii-air inlet. Your committee consider the fresh-air inlet an essential. 
Its action is two-fold. The current of air which it stimulates is a prevent- 
ive to the formation of gases, and is a medium of safe removal of such as 
may form. The arrangement of the inlet to prevent freezing is easily 
provided for, and such a difflculty is in no sense a valid objection to its 
use. In regard to the large sewer, a part of the city system, we are at a 
loss to understand tlie necessity of its location within the walls of the 
State House building, but if sueii is tlie case it undoubtedly should be of 
heavy iron pipe. Bricks and cement mortar furnish hut an imperfect op- 
position to the passage of sewer gas, and tiieir use within the walls of a 
habitation as a container, as is the case in a large unventilated sewer, or 
as both container and conductor, as when the soil pipe is entered into a 
chiumey line, is of the most reprehensible character. 

The data in the fifth question, for its specific application in this case, 
are insnfiicient. In general terms it would be answered in the atfirmative. 
We have not thougiit it necessary to discuss to any considerai)le degree 
the reasons for our condemnation of the methods pursiUMl in the Indiana 
State House, or for those reconunended, because it is common knowledge 



196 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

to those who have made themselves competent to judge that the princi- 
ples in the first case are known to be and found to be vitally defective, 
while on the other hand those recommended may be considered to have 
passed through the speculative and experimental period and become fairly 
fundamental. 

We commend the action of the State Board of Health of Indiana in its 
endeavors to bring about a correction of the errors so manifest in the 
principles that appear to have guided the plumbing of their new State 
House, and upon its insistence that the plumbing of its State buildings 
should always conform to and keep pace with the advances made in sani- 
tary science. 

All of which is respectfully submitted. E. C. Jordan, C. E. 

Wm. Canniff, M. D. 
G. B. Thornton, M. D. 



Water Supply, Public and Domestic. 



By J. O. "Webster, M. D., of Augusta, Member of the Board. 



The importance of the purity of a towffs water supply, to the 
health of its inhabitants, is shown b}' the fact that from 70 to 100 
ounces of water are required daily b}' an adult, of which from 20 to 
30 ounces are contained in solid food, leaving about 60 ounces to be 
supplied b}- some form of liquid. 

Besides its dietetic use, a large amount of water must be employed 
daih' in the A^arious mechanical operations of the household, so that 
the whole quantity needed for a family suppl}', exclusive of baths or 
water closets, is about 12 gallons a day to each person. The amount 
actuall}' used, wherever there is a free supplv b}' aqueduct, is greatly 
in excess of this. For all purposes there should be allowed, in a 
large, manufacturing cit}', 60 gallons a day to an inhabitant ; in 
smaller towns, 35 or 40 gallons. 

Pure water is a chemical compound of hydrogen and oxygen, two 
parts of the former to one of the latter, but this is a theoretical sub- 
stance and does not exist in nature. All natural waters, however- 
pure, contain a large amount of atmospheric air, some free oxygen, 
carbonic acid, and more or less salts of various kinds. 

The kinds of water available for domestic use maj' be variously 
classified, but for our present purpose it seems most convenient to 
designate them as rain, spring, ivell, lake, and river water. In one 
sense all could be classified under the first head, since all are derived 
from the rain, but under such different conditions as to cause a great 
variation in their qualities. That this is tlie case is not fully realized 
by many persons, and a recent lecturer in England, John Evans, 
Esq., has well said : 

(lil7) 



198 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

"I have heard people speak of vast and inexhaustible stores of 
water, which have been laid up in the body of the earth for untold 
ages, and which have merely to be tapped to meet all the necessities 
of a crowded population, or of springs, as if there were some spon- 
taneous process in nature b}' which water was produced in unlimited 
quantities, but all the water derives its existence from no other source 
than the heaven above." 

RAIN WATER. 

Rain water is usually pure as collected. It becomes well aer- 
ated by the absorption of air in falling through it, but its supply of 
carbonic acid is small, being only the amount derived from the at- 
mosphere, for which reason it is flat and devoid of the sparkling 
quality of spring or well water. la cities it may contain carbon 
from smoke, and other impurities washed out of the air. Unless 
care be taken that the roof is well washed bv rain before the con- 
ductors are connected with the cistern, the water ma}' be soiled by 
dust from the streets which has collected upon the roof, containing 
organic matter that will soon spoil it. Water stored in a cistern 
may be contaminated bj* impui'e air, by foul ground-water entering 
through leaks, or by other kinds of filth accidentally gaining access 
to it. A frequent cause of impurity' is the connection of the over- 
flow pipe with a drain, permitting the entrance of sewer gas. Such 
connection should never be permitted. 

Cistern water is unfit for domestic use unless the cistern be often 
cleaned ; and considering its great liability to contamination, it is 
not to be recommended as a source of domestic water supph' save 
in exceptional cases. 

Rain water is often collected from the surface of the ground of a 
natural water-shed and stored in an artificial pond, formed by dam- 
ming a valley or water-course. If the water-shed be uninhabited 
and devoid of sources of filth, and if all vegetable matter, loam 
and peat be removed from the storage basin before it is filled, such 
a source of water supply is unexceptionable. If the vegetable mat- 
ter be left to deca}', the water will be colored and uninviting, per- 
haps for several years, but it is not proved unhealthy. 

The water collected from natural water-sheds may be contami- 
nated by any source of filth that exists there, or b}' sewage or refuse 
fi:om manufactories flowing into its storage basin. The recent epi- 
demic of typhoid fever at Plymouth, Pa., is only one of many in- 



WATER SUPPLY, PUBLIC AND DOMESTIC. 199 

stances of the poisoning of a water supply by the excreta of the 
sick. 

SPRING WATER. 

"When the rain falling upon somewhat elevated ground is absorbed 
and finds its way into an underground eliannel througii wiiich it is 
carried, perhaps a long distance, until il emerges upon the surface 
of the earth, a spring is the result. It is easy to see, therefore, that 
spring water is not necessarily pure ; — it may acquire impurity at its 
source or its place of exit, or it raa^' have absorbed dt-leterious 
chemicals in its transit. We do not usually know the source of our 
springs, but fortunately it is apt to be in some uninhabited region 
where no filth exists. 

Spring water is highly charged with carbonic acid derived from 
the ground air, which contains many times as much as the air we 
breathe, and this gives it its sparkling appearance and refreshing 
taste. It is usually hard, from minerals dissolved during its course 
through the ground, mainl}' salts of lime, but many kinds of salts 
are found in the water of mineral springs. 

Spring water, if not too hard, and if found to be free from con- 
tamination, is a reliable source of water supply for one or a few 
families ; but however large the amount of water furnisht'd liy springs 
at first, it cannot be depended upon as a constant supi)ly lor a cit}' 
or village. 

WELL WATER — GROUND-WATER. 

At a varying distance below the surface of the earth, -there is found 
everywhere a body of water occupying the interstices between the 
particles of soil or gravel, the same as the ground-air does above 
this level, and flowing slowly towards the sea or the nearest water- 
course. This is called the ground-water, and it constitutes about 
forty per cent of the strata of soil which it occupies. Its surface is 
not level but slopes towards its natural drainage outlet, from two to 
eight feet in a mile. Its inclination results mainly from friction, — 
though the underlying stratum somewhat influences its slope, — and 
this inclination is fully as great as that of the stream flowing through 
the same valley. 

The rain-water sinks through the soil until it comes to an im- 
permeable stratum of rock or clay, above which it collects and the 
stratum forms the bottom of this subterranean river. Lower still 
there may be another stratum, with another collection of ground- 



200 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

water which has got access to the space between the two at some 
point where the upper stratum is deficient, and is steadily flowing on 
in the same direction. 

A well, whether dug, bored, or driven, is siuiply a cylindrical 
shaft extending down into the ground-water, and the water in the 
well stands at the same level as that in the soil. Were the water in 
a well wholly undisturbed, there would be a constant but impercepti- 
ble current in it in the direction of the flow of the ground-water, 
and there would be no flow into the well save from one direction ; 
but when water is drawn, the level is lowered below that of the water 
in the soil and inflow takes place from all directions. If a well is 
freely used, this inflow is liable to occur from a distance of one 
hundred feet laterally, but in the direction from which the ground- 
water flows, the inflow to the well will come from a much greater 
distance. This limit of one hundred feet applies only to ordinary 
cases. An experiment performed in Germany showed that if the 
water in the well was kept eight feet below its normal level, by 
pumping, the height of the ground-water was affected, in every 
direction, for a distance of about two hundred feet. 

Hence, ordinaril}-, a source of filth, in order to contaminate a well, 
must be within one hundred feet, or in extreme cases two hundred 
feet, except in the direction from which the ground-water flows 
naturally. In this direction it may be at a great distance, especially 
if the subterranean river flows through quicksand. But this is not the 
whole truth, for the original source of filth may be much further 
removed and* have gradually defiled the soil in the direction of the 
well until it lias extended within its influence. Cess-pool filth has 
been known to permeate through the soil for a distance of two hun- 
dred yards and poison wells. There is also danger of contamination 
from surface drainage, especially in a gravelly soil. To avoid this, 
the upper part of a well should be made water-tight and the ground 
should always be kept scrupulously clean within one hundred feet. 
No drain, unless water-tiglit, no cess-pool, sink-drain, privy, or other 
source of filth, should be allowed within this distance. 

The general characteristics of well water are similar to those of 
spring water, but from sandy soils it is deficient in carbonic acid and 
is not sparkling and refreshing. It contnins a varia))l(! amount of 
mineral matter, pi'incipally the salts of lime, soda and magnesia. 
Unless too hard, it is more palatable and is thought by some, if pure, 



WATER SUPPLY, PUBLIC AND DOMESTIC. 201 

to be healthier for drinking than pond or river water, but its liai^ilit}- 
to polUition renders its use often hazardous. 

In a small, rural village, the suppl}' of water from wells ma}' have 
been of unexceptionable quality for an indefinite time ; l)ut the place 
grows, population becomes more dense, the ground-water is drawn 
upon in excess of its supply, the drainage area of the wells is increased, 
and the water becomes less pure, both from this cause and from the 
increased amount of sewage returned to the soil, which is sure to 
become saturated with organic matter beyond its powers of oxidation, 
and pollution of wells is inevitable. The}' should be entirely aban- 
doned as a source of water supply for household use, wherever there 
are over two houses to an acre of land. P2ven on isolated farms the 
well ma}' be polluted, but only from the grossest carelessness in 
regard to its location and its relation to buildings and other sources 
of filth. 

It has been often proposed to supply large villages or even cities 
with water from numerous wells located in the neighboring country. 
The sup[)ly from such a source may be ample at first, but it will 
constantly grow smaller, the level of the ground-water will fall, and 
the supply may fail. The supply of water in the soil is not inex- 
haustible and cannot be drawn upon indefinitely. It all comes from 
the rain-fall, and this cannot be depended upon for more than four or 
five inches a year to supply the wells and rivers of a district. That 
taken from the wells is so much taken from the sources of the neigh- 
boring streams, though it may be returned to them after using. "When 
the plane of saturation falls, so as to be flatter than the inclination 
of a valley, the stream flowing through it dries up. 

Sometimes, however, the rain-fall of a natural water-shed, instead 
of forming a stream or pond, is absorbed by the porous soil of a val- 
ley, forming an underground pond which can be depended upon for 
a definite amount of water, depending upon the extent of its water- 
shed. If the latter be large enough and clean, wells sunk in such a 
location will form an excellent source of public water-supply. 

Filter-galleries have been constructed in several places, — a large 
trench near a river, with the idea that the river water would filter 
through the intervening soil into it. As a matter of fact, most of 
the water in these galleries is derived from the ground-water, the 
flow of which is towards the river. The water is usually harder than 
that of the river, is of more uniform temperature — warmer in winter 
and colder in summer — and its level is higher if pumping has been 



202 STATE BOARD OF HEALTH SPECIAL PAPERS. 

interrupted for a considerable length of time. It is subject to the 
same risks of contamination as well water. 

Some writers have undertaken to make a distinction between ordi- 
nary wells and "deep wells." The latter extend through an imper- 
meable stratum into a water-bearing stratum below, which is, however, 
connected with the upper ground-water stratum at a locality more or 
less remote. Their water is ground-water and they have not neces- 
sarily an}' advantage over shallow wells ; but as a matter of fact, 
their water is usually very pure, but hard. 

An artesian well, properly so-called, belongs however to a differ- 
ent class. It is an artificial opening into a pervious stratum between 
two impermeable strata, where the water exists under pressure, hav- 
ing its source at an elevation. If the water found its way to the 
surface through a natural opening, it would form a spring ; hence it 
may be pure or impure, under the same conditions as spring water. 
The water of artesian wells is of very uncertain character, being 
often worthless from the large amount of mineral matter. It is gen- 
erally free from organic contamination. 

LAKE OR POND WATER. 

The water of lakes and ponds is derived directly from the rain- 
fall, collected from natural water-sheds. It is generally of great 
purity, from their usually secluded position and the cleanliness of 
their water-sheds, and from their action as settling-basins for all 
suspended matter. 

"There is no instance of a populous town having grown up on the 
banks of any one of these lakes in Massachusetts." [Mass. S. B. 
H. Rep. Vol. 4.] Hence lakes or large ponds are regarded, as a rule, 
as the safest source of public water sup[)ly for cities and large towns. 

TlH;ir water is soft, well aerated, but apt to be flat from its small 
amount of carbonic acid. The water of ponds, whether natural or 
artificial, is liable to be affected by the growth of fresh-water sponges, 
or of the cla8S of plants called Algae. The former, by tlieir decay, 
may give the water a disagreeable appearance and odor, but this is 
not proved injurious to health. The latter are often so line as not 
to be distinguished in a glass of water, but to larger quantities they 
impart a greenish hue, and the; use of the water so affected is apt to 
cause diarrlKJua. They can be removed by filtration, but will (piiekly 
clog the filter, and are speedily reproduced in the filtered water. 



WATER SUPPLY, PUBLIC AND DOMESTIC. 203 



RIVER WATER. 

River water is more complicated than the kinds hitherto men- 
tioned, since it is derived partly from the surface drainage of its 
water-shed, and that of its tributaries, and partlv from the rain 
water that is absorbed by the soil and flows as groiiml-water into 
the river-channel, which is the natural drain of a large tract of land. 
It is better aerated than pond water, from its prolonged contact 
with air while in rapid motion, and better carbonated from the ab- 
sorption of carbonic acid by that portion of it which soaks through 
the ground. It is not so soft as pond water, but is more palatable, 
though less so than that of springs and wells. 

It is liable to contamination to a greater degree than the water of 
ponds, since cities or villages and manufactories are oftener situated 
upon the banks of rivers than upon the shores of ponds. 

It was long thought that running water wotdd purify- itself, that 
any sewage flowing into a river was destroyed by oxidation in the 
course of 20 miles' flow, and many facts tend to support this suppo- 
sition. Instance, the Blackstone River in Mass. ; after receiving sew- 
age equal to 5 per cent of its volume, and flowing 20 miles, the 
analysis failed to show much difference between the water of the 
river at this point and its head waters. [Mass. S. B. H. Rep. Vol. 
7, p. 146.] The river Seine becomes, about 55 miles below Paris, as 
pure as before reaching that cit}'. [Annales d'Hygiene, Jan., l-SsT.] 

Several factors seem to be concerned in this apparent purification. 
Oxidation does occur to some extent, and the experiments of the 
English Rivers Commission indicate that, in flowing twenty miles, 
from twenty to thirty per cent of sewage matter might, in summer, 
be destroyed by oxidation. Then, precipitation is constantly going 
on and suspended matters are rapidly- removed by this means. But 
most of the apparent purification of running streams results from 
the great dilution of the sewage by the constant increase in the vol- 
ume of a river, both from tributary streams and from the inflowing 
ground-water. In this way the poisonous matters may be so diluted 
as to be beyond the powers of chemical analysis to detect, and yet, 
should the germs of disease have been present, they are still there 
and as powerful for evil as ever. Dr. Frankland, the highest 
authority on this subject, says : 

"There is no process practicable on the large scale by wlii<ii that 
noxious material (sewage-matter) can be removed from water once 



204 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

SO contaminated, and therefore I am of the opinion that water which 
has once been contaminated by sewage or manure matter is thence- 
forth unsuitable for domestic use." 

"If a stream has received much filth in its course, its waters should 
be considered objectionable and to be avoided for human use ; unless 
indeed the volume should be so great compared with the filth-pollu- 
tion as practicall}' to be independent of such reasoning. If sewage 
contain the germs of disease, whatever they may be, no agenc}' at 
present known, except a sufficiently high temperature, will efficiently 
destroy them." [Mass. S. B. H. Rep. Vol. VIII, p. 283.] 

Rivers are such convenient sources of water supply for the cities 
lying upon their banks, that there is great danger that they ma^' be 
drawn upon for that purpose, without sufficient regard being paid to 
their possible sources of pollution ; so that it has been thought best 
to dwell, at considerable length, upon this part of our subject. The 
immense volume of the Kennebec, Penobscot and Androscoggin 
rivers probabl}' secures them practically against danger ; but it would 
be much better to bring water a long distance from a pond, than to 
risk taking it from an3' other river of the State after it has passed a 
city or large town. 

DISTRIBUTION. 

The carriage of water, — that is, its distribution by pipes, — is au 
important element in its healthfulness. Iron pipes do not injure the 
water, but the reverse is not true, as the pipes themselves are filled 
with rust and rendered useless in a few years unless protected. The 
best protection for cast-iron pipes is a coating of coal-tar, which is 
applied at a temperature of about 500°. The most convenient sub- 
stance for house water-pipes is lead, but it is unfortunately dissolved 
by some — mostly soft and very pure — waters. Carbonic acid and 
the carbonates in water protect lead pipes. With sufficient care in 
always Jetting as much water as the pipes hold run to waste in the 
morning, there is little danger in using lead for service pipes. A 
gallon of water should be tlirown away for each twenty feet of one- 
inch or eight feet of one and one-half inch pipe. 

For street mains, iron pipe alone is suitable. 

FILTRATION OK WATKR. 

With a view to the removal of any impurities that may be present 
in a water supply, filtering is often resorted to. Cistern water should 



WATER SUPPLY, PUBLIC AND DOMESTIC. 205 

always be filtered, and for this purpose the commonly-used brick par- 
tition is efficient for a time, but it soon becomes covered with a 
deposit that injures rather than benefits the water ; it should be fre- 
quently cleaned. The filtration of a general water supply may be 
either central — before distribution, or peripheral — at the houses of 
consumers. For central JiUralion we use filter-material of sand and 
gravel, freed from loam by washing, and screened into lots of uni- 
form-sized particles. A water-tight filter-basin is built and the ma- 
terial is arranged in it in layers, the coarsest at the bottom. A pipe 
brings the water to the top of the filter, and another at the bottom 
conducts away the filtered water. Water is brought to the filter 
either immediately from the source, or after first standing in a set- 
tling-basin. 

An ordinary arrangement of the filter material is the following, 
from the top downward : 

12 inches fine sand. 



12 " 


coarse sand, 


6 " 


fine gravel, 


6 " 


medium gravel, 


6 " 


coarse gravel, 


12 " 


broken stone, 


54 inches 


in all. 



Its action upon matters in suspension is two-fold ; large particles 
are arrested at the surface, — with regard to finer particles the process 
is one of sedimentation and adhesion ; and some action takes place 
upon dissolved matters b}- oxidation. 

It cannot, however, be depended upon to remove the turbidity 
from finely-divided clay, or the brown ish-3'enow color of water from 
peaty meadows or artificial ponds ; and it is not proved that filtering 
removes organic germs to any extent. 

The filtration of the Thames water "not merely removes the sedi- 
ment which may be in suspension, but it removes a large portion of 
the organic matter, — forty per cent, Dr. Frankland says, — which finds 
place in the natural water of the river." [Mass. S. B. H. Rep., Vol. 
VIII, p. 29.] 

Water should not be stored after filtration, but should be delivered 
at once to consumers. 

Dr. Frankland has found ferruginous sand more efficient for fil- 
tering than sand that is free from iron. 



206 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

"For the purification of general water-supply, simple filters of 
ferruginous sand, combined with means for agitation and thorough 
aeration, will probabl}- be satisfactory'." [San. Eng. 7, October '86.] 

The expense of filtering a general water suppl}' has been so great 
in England, that American cities have been slow to adopt it, — the 
cost being from $2.50 to $3.00 a million gallons for sand filtration as 
ordinarily conducted, and as described above. 

Filters containing " spongy iron" have been used very effectively 
at Antwerp since 1881. Simple straining through sand is all that is 
needed to remove sawdust, as at Bangor. As most of the matters 
removed in filtering are retained by the upper one or two inches of 
fine sand, the surface requires frequent removal and, after a time, a 
supply of fresh sand. To avoid this necessity, filters have been 
constructed with an arrangement for forcing filtered water up through 
the filter-bed, at the same time stirring the surface mechanically and 
pumping out the water until it is perfectly clean. Such a filter is in 
successful use at Cumberland Mills, and one has been built at Au- 
gusta, which is figured and described at the end of this paper. 

Y or periiiheral — or household — filtration, a great number of appa- 
ratus have been devised, using an almost endless variety of filter-mate- 
rial. 

It is impossible that any of the small filters made to be attached to 
water- faucets can act otherwise tlian as simple strainers ; and a cotton- 
flannel bag tied to the faucet, although not so ornamental, is quite 
as useful. 

A sand-filter can be readily made from a large flower-pot, by putting 
a layer of coarse gravel in the bottom, then finer gravel, then fitie sand. 
All the particles in a layer must be of a size, or the filtering will not 
be eflicient. 

Animal charcoal (bone-coal) has been regarded as the best material 
for domestic filters, though the so-called spongy iron has some claims 
to pr( eminence. A well-constructed filter containing either of these 
substances will, undoubtedly, accomplish much towards purifying 
water, both mechanically and chemically. Thcjiltre rapide, used by 
Gen. Wolsele}' in Africa, seems to be a good example of the former 
kind ; hut ho patent filter should be used without knowing what the 
filtering material is, as many of them are worthless. Wliatever 
material is used, it nnist be occasionally renewed or it will injure the 
water instead of improving it. 



WATER SUPPLY, PUBLIC AND DOMESTIC. 207 

Dr. Smart's filter is as good as many patented articles. It is of 
tin, funnel-shaped, the upper end of the tube projecting half-an-inch 
into the body of the funnel (tunnel). A cloth is tied over the bot- 
tom of the tube, which is three-fourths filled with granulated bone 
charcoal and the upper fourth with sand ; and a cloth is tied over the 
top of the tube. The upper cloth must be occasionally removed and 
washed and half an inch of the sand replaced by new. After a time, 
the whole contents of the tube must be renewed. 

INIuch of the interest that attaches to the filtration of water has of 
late cencentrated itself upon the possibility of filtering out organic 
germs. While the water of springs and deep wells is comparativel}' 
free from these organisms, surface-water contains great numbers. 
Most of them are harmless, but there is always the possibility that 
the specific germs of disease may be present. 

For two forms of filter — Chamberland's, of unglazed porcelain, and 
the INIicro-merabrane Asbestos Filter — strong claims are made of 
their ability to completely remove organic germs. They are both 
very efficient forms of filter, but their claims in this respect are still 
subjudice. Many experiments have been made with numerous forms 
of filter to ascertain their efficiency in removing these organisms, but 
the results are so contradictory that no conclusions are justilied. It 
seems probable, however, that many substances can accomplish this 
when first put in use, but that the power is very soon lost. 

CHEMICAL PURIFICATION. 

The removal of suspended matters, from a somewhat hard water, 
may be accomplished by adding a small amount of alum or perchlo- 
ride of iron. Hydrate of alum or iron is formed, which is insoluble 
and, in settling, carries down the otlier substances with it. The 
Hyatt system of filtering uses this process, loUowed by sand filtra- 
tion. On the small scale, organic matter may be removed by the 
addition of permanganate of potash, which oxidizes it. 

HARD AVATEK. 

There are two kinds of hardness of water— temporary and per- 
manent. The first is so called because it is removed by boiling, and 
is owing to the presence of bi-carbonate of lime. By boiling, carbonic 
acid is driven oH', leaving the carbonate of lime, which is insoluble 
and forms the scale upon tea-kettles. The hardness may be cheaply 



208 STATE BOARD OT HEALTH — SPECIAL PAPERS. 

removed by adding lime-water, the lime in which unites with the 
extra carbonic acid and forms carbonate of lime, which settles. Soap 
or washing soda will soften such water, but quite expensively. Per- 
manent hardness is mostly caused b}' the presence of sulphate of 
lime. Such water may be softened b}' adding carbonate of soda 
(washing soda) , which reiicts with the sulphate, forming carbonate of 
lime, which settles, and sulphate of soda, which remains dissolved. 
This process is too expensive for any but domestic use ; but the re- 
moval of temporary- hardness is practicable for a public water supply. 
Boiling not only removes temporary haidness, but also ha« con- 
siderable effect in purifying water. Organic germs are, in large 
part, removed by this means ; and although some forms of bacteria 
resist the boiling temperature, disease-germs are probably nearly or 
quite all destroyed by it. 

IMPURK ICE. 

The well-known fact that water in freezing excludes some of its 
dissolved constituents has led to the supposition that it accomplishes 
a complete purification in this way. Such is not the case, for organic 
matter, — and especially its most dangerous form, the germs of dis- 
ease, — is not wholly removed by freezing. Dangerous epidemics 
have been caused by the use of impure ice, notably those at Rye 
Beach, N. H., in 1875,— [Mass. S. B. H. Rep., VII, p. 465,]— and 
at Washington, Conn, in 1879,— [Conn. S. B. H. Rep. II, p. yOth]. 
Ice for domestic use should not be cut from a pond which is unfit for 
a source of water-supply. 

James T. Gardiner, Consulting liingineer to the N. Y. State Board 
of Health, after a thorough examination of the subject, arrived at 
these conclusions : 

" First. Ice frozen from impure water has caused illness. 

" Second. Ice may contain from eight to ten per cent of the or- 
ganic matter dinsolved in the water from which it was frozen. 

" Third. Ice may contain, in addition to the dissolved impurities, 
a very large amount of organic matter which had been suspended or 
floating in the water Ijefore freezing. 

"■Fourth. Ice ma}' contain living animals and plants from the 
size of a visil)le worm down to the minutest spores of bacteria and 
the vitality of these organisms be unaffected by freezing." 



WATER SUPPLY, PUBLIC AND DOMESTIC. 20? 



EFFECTS OF IMPURE WATER. 

Impure water may act in either of three ways to produce disease : 
First, the digestive organs may be affected by the direct contact of 
the contained impurities ; second, after absorption, it ma}' occasion 
impairment of the general health, or, third, it ma}- conve}' disease 
germs which gain entrance to the system and set up specific diseases. 

1st. Man}' very hard waters, and some containing iron, cause 
d^'spepsia and, especiallj- those impregnated with sulphates of soda 
and magnesia, diarrhoea. The latter is a well-known effect upon 
strangers, of the water in some parts of the west. 

Diarrhoea is frequently caused b}' organic matter in water, as the 
teachings from vaults, drains, cesspools, or other sources of filth. 
This is also a common cause, if not the commonest, of dysentery, 
besides which the water may probably carry the specific cause of the 
disease derived from sewage. Sewer gas absorbed by water, as in 
a cistern whose overflow pipe connects with a drain, may cause diar- 
rhoea. 

2d. Either directly, or as a result of derangement of the digestive 
system, the use of bad water is apt to occasion a condition of malaise, 
and a feverish state without the signs of a specific fever. It also 
makes its user more vulnerable to any acute disease. 

A small amount of sewage contamination, in drinking water, may 
not show any sensible effects upon the health of its users in ordinary 
times ; but at the approach of an epidemic — like cholera — there is a 
wide difference against those places supplied by the impure water. 
This has been shown unmistakabl}* by a careful analysis of the 
London cholera epidemics of 1849, 1853, and 1866. 

3d. In malarial regions, the water of marshes — as well as the air 
passing over them — conveys the malarial poison. This is well es- 
tablished, although the poison is oftener carried by the air. 

Probably much the most frequent way in which the germ of typhoid 
fever gains access to the body is by the medium of drinking water 
contaminated with the discharges from a previous case of the dis- 
ease. The epidemic at Plymouth, Pa., is fresh in our remembrance, 
but many as striking instances were previously well known. Dr. E. 
D. Mapother, of Dublin, reported an instance, where forty cases of 
typhoid fever occurred in a hospital which received its water supply 
from a river. The cause was traced to some barracks, twenty-five 
14 



210 STATE BOARD OF HEALTH SPECIAL PAPERS. 

miles higher up. from which Uplioidal dejections had been emptied 
through drains into the river. 

AVhether water contaminated by sewage can originate typhoid fever, 
if the poison from a previous case of the disease be absent, is a question 
still unsettled, with strong arguments on both sides ; but it is certain 
that tliis disease is connected, in a large proportion of cases, with 
the use of water impregnated with excrementitious matter, and this 
is the practical point, wliile the presence or absence of a specific 
germ is theoretical. It is a safe ride to avoid the use of such water. 
In cases of typhoid fever, the dejections should be carefully disin- 
fected and so disposed of that it is impossible for them to be washed 
into any source of water supply. 

It seems well established that cholera may be propagated l)y the 
defilement of water with the discharges from subjects of the disease ; 
besides which, as already stated, persons who are using an impure 
water, especially that tainted with sewage, are more lial)le to the 
disease when it is prevalent. The epidemics of cholera appear to 
take their rise in India, from the defilement of the water that takes 
place every twelve years at Hurdwar, on the occasions of the pil- 
grimages. 

Diphtheria and scarlet fever may be spread by means of water 
which has become, in some way, impregnated with their germs ; but 
tiie more common way in which impure water is connected with the 
prevalence of these diseases is probably by making the system less 
able to withstand the specific poison, and rendering the attack more 
malignant. And this is an important point, that will bear repeating, 
that impure water renders the system more vulnerable to almost any 
form of disease. 

TKST8 . 

If water looks, smells, or tastes Ijadly, any one is likely to suspect 
it of impurity and desist from its use ; but sometimes the water that 
appears unusually good, to the senses, contains a large amount of 
organic matter, and perhaps the germs of disease. The latter cannot 
be detecUid by any means at present known, but there are some 
simple tests, that can be used by any person of intelligence, for the 
detection of organic matter in water. 

Ist. To a half pint of water, in a perfectly clean bottle, add a 
half teaspoonful of pure granidated sugar, cork tightly, and keep at 
a temperature of 70° F. If the water becomes turbid and offensive 
within forty-eight hours, it contains a dangerous amount of organic 
matter. 



WATER SUPPLY, PUBLIC AND DOMESTIC. 211 

2d. Dissolve 8 grains of i)ure potassium permanganate iu 1 ouiu-e 
ot distilled water. To a half pint of the suspected water, in a 
tunil)ler. add one drop of this solution. If the red tinge disa|)pears 
in half an hour, add another drop, and so on until a slight tint is 
lelt. For everv dntp that loses color the water conlains lium 1| to 
•J grains of organic matter to the gallon. If the loss of color is 
rapid, the organic matter is probably animal, if slow, vegetaljle. 

These tests, however, are crude and imperfect, and a positive result 
will only furnish a strong indication for the necessity of a thorough 
analysis by a competent chemist ; while u negative result will only 
-thow that the water is probabi;/ pure. 

CONCLUSIONS. 

First Cistern water, owing to its lial)ility to [jollution, is not 
<lesirable for a domestic supply ; but with proper care and precau- 
tions, it may be safely used when nothing better is available Under 
many circumstances, it is to be preferred to well water. 

Second. Spring water is usually pure but necessarily so. Its 
purity should be established by suitable tests. When pure and not 
too hard, it is the best water possible for domestic use, but is larely 
furnished in sufficient abundance for public supply. 

Third. Well water, in a thinly settled neighl)orhood. and with 
proper care in the location of the well and the exclusion of surface 
drainage, and unless the water be very hard, is well suited for domestic 
use. It should never be used in a city or village. Oroiuid-water 
from '-filtering galleries" or from large wells, if the conformation of 
the ground be such as to insure an abundance, and freedom from 
contamination be .secured, forms an excelU-nt pul)lic supply ; l)ut the 
necessary conditiDU.s aie rarely found. 

Deep wells often furnish good water when tiiat from shallow wells 
in the same locality is bad. 

Fourth. Pond or lake water, when the water-shed from which it 
is collected is known to be free froni any s(Muce of filth, is the most 
desirable for public water sup[)ly. 

Fifth. River water, from the fact that a river constitutes the 
natural drainage-channel for a large ti-rritory. and that cities or large 
villages are commonly situated upon its l)anks, is usually a very 
questionable source from which to draw the water supply of a town 
or city. Unless the volume of the river be very large, and the vil- 
lages upon its banks small, it should be unhesitatinglv condemned. 



THE WARREN FILTER. 

This is the filter already mentioned, as being in use at Cumber- 
land Mills and Augusta. Its construction and method of operation 
will be well understood from the following plates and description. 

Fig. 2. Filter in Operation and Reservoir. 

A, Filter tank filled with water. 

B, Storage reservoir. 

C, Inlet or supph' pipe. 

D, Outlet or filtered water pipe. 

E, Waste pipe to waste pump or sewer. 

F, Upper waste gate to empt}' tank above filter bed. 

G, Lower waste gate to space below filter bed. 
H, Filter bed — fine gravel, 15 inches thick. 

I, Agitator — slightly harrowing surface of filter bed. 
K, Agitator shaft, revolves 6 revolutions per minute. 
L, Sleeve witii rack and pinions and hand wheel for raising and 
lowering agitator. 

M, Gears and pulleys for rotating shaft. 



(213) 



Fig. 3. Cleansing Procp:?s. 

A, Fflter tank with water drawn ofif. 

B, Storage reservoir. 

C, Inlet pipe with gate closed. 

D, Outlet pipe, water passing from reservoirjto tank. 

E, Waste pipe carrying away water fouled with sediment. 

F, Upper waste gate open. 

G, Lower waste gate closed. 

H, Filter bed — being stirred with the agitator. 
I, Agitator lowered into the filter bed. 
K, Agitator shaft, slowly revolving. 

L, Sleeve and hand wheel for raising and lowering agitator. 
M, Mechanism for rotating shaft in any position. 



(215) 



216 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

The operation of the system is best shown by the accompanying 
cuts. The water to be filtered, Fig. 2, in section, passes into 
an open tank, preferably of brick, although wood or iron may 
readily be used. These tanks may be of any size, but the uniform 
size of 8 feet diameter, thus affording an area of 50 square feet of 
filtering surface to each tank, will be found convenient. Near the 
bottom of this tank is placed a grating or false bottom of wood 
covered with a plate of perforated copper, fine enough to prevent 
the grains of the filtering material from passing through into the 
space below. On this rests the filter bed, which should be about 15 
inches in thickness, and consisting of carefully selected and sifted 
gravel of uniform fineness throughout. The water passes through 
the inlet gate, and percolates downward through this filter bed into 
the space below, leaving its sediment, and then passing through the 
outlet gate to the pump or storage reservoir, as the case may be. If 
two or more filters are used in conjunction, a storage cistern will not 
be a necessity, as in that case one filter may be cleansed at a time, 
the others affording water for the purpose. The rate of filtration, or 
the amount of water which a filter of this size will afford, depends 
so much upon the character of the water to be filtered that no defi- 
nite rule can be given. It is evident that time is an important factor 
in the process, and that better results may be obtained by allowing 
the water to percolate slowly through the filter bed than if forced 
through more rapidlj'. In the extensive filter which has been in use 
at Cumberland Mills, Maine, for the past two years, affording 12 
million gallons dail}', we have found that a flow through the filter 
•bed of one foot per minute, which would aflford one cubic foot of 
water to each square foot of area in the filter beds, amounting to 
more than a half million gallons daily for each filter of the proposed 
«ize, may usually be promoted by a head of from one to two feet. 
That is, the water in the storage gallery, from which 12 million gal- 
lons daily are pumped, will ordinarily stand at a level of from one 
to two feet lower than the water in the supply canal from the river. 
If the level falls below two feet the filters are cleansed. A much 
larger amount might l)e pumped by allowing more difference of head, 
but with somewhat less elfect in cleansing the water. The process 
at this rate is complete enough for all the requirements of a paper 
mill in which all the best qualities of printing paper are made, and 
wouhl be suflicient to cleanse the ordinary water supply for cities 
and towns. 



WATER SUPPLY, PUBLIC AND DOMESTIC. 217 

To cleanse the filter bed, Fig. 3, it is simply necessary to close the 
inlet gate and open the sluice or waste gate, which will allow the 
water in the tank to escape, and as soon as it has reached a level 
lower than that of the water in the storage reservoir the water which 
has already been filtered will begin to boil np through the filter bed 
and pass off through the sluice, carrying with it the entrapped sedi- 
ment. 

This, however, is not in itself sufficient, as many who have tried 
it will testify, as the water will break up through in spots when it 
can do so the most easily, leaving much of the bed unchanged, and 
it remains to complete the i)rocess by stirring the filtering agent, 
which is accomplished by means of a vertical shaft revolving in the 
centre of the tank, carrying at its lower end an arm to which are 
attached teeth, the whole of which may be raised or lowered by 
means of the hand wheel, so that the teeth ma}- plow up the filter 
bed to any required depth. The action of the water, together with 
the stirring and the attrition of the grains of the filtering agent upon 
each other, will rapidly and effectuall}* cleanse the filter bed. When 
the process is complete, which may occup}- from five to ten minutes 
for each filter, close the waste gate and again admit water at the in- 
let, and when it has again risen above the level of the water in the 
storage reservoir the process of filtration will go on as before. The 
lower waste gate is only needed when it is desired to empty the en- 
tire tank and expose the filter bed, which it is not necessary to do in 
the ordinary process of cleansing, as the waste gate is placed far 
enough above its surface to prevent the escape of the filtering agent 
when the current is reversed. 

Although the primary object of the agitator is to cleanse the filter, 
the process of filtration may be greatly promoted b}' allowing the 
teeth to scratch the surface of the filter bed while this process is go- 
ing on. The deposit of the sediment will be largely at the surface, 
where it will tend to form in time an impervious film, which the teeth 
of the agitator will break up and incorporate with an inch or two of 
the surface gravel instead ; and again, much of the material in water 
which is barely buoyant enough to float along the bottom may be 
kept afloat by the slow motion of the agitator arm and not permitted 
to settle down upon the surface of the filter bed. By this means 
the cleansing process may be less frequent than would otherwise be 
necessary- 



218 STATE BOARD OF HEALTH SPECIAL PAPERS. 

It may sometimes be found necessary to carry the process further 
than can well be accomplished in a single filter, in which case two or 
more can be combined, using different grades of material as to fine- 
ness. Aside from the question of first cost and greater amount of 
room required, the process may thus be carried to an}' extent, and 
work as simply and conveniently as in the single filter. A water 
supply naturally impure may thus be cleansed from everything of a 
sedimentary nature. That which is held in solution can only be re- 
moved by the action of chemical agents, a process entirely inde- 
pendent of simple filtration, and which may be used as readily and 
effectively with this s^'stem as with an}' other. 

The advantages claimed for this filter may be summed up as follows r 

1st. It provides the required amount of filtering surface at the least 
cost. 

2d. The water comes in contact with tiie filter bed without the in- 
tervention of any screens which rapidly become clogged and are 
more difficult to cleanse than the filtering agent. 

8d. The surface of the filter beds may be raked while the filtration 
is going on and their efficiency greatly increased thereby. 

4th The filter bed is easily and effectiveh' cleansed, and without 
interfering with the operation of the other filters in the system. 

5th. All oily matter of a less gravity than the water floats upon' 
the surface and is drawn off at the waste in cleansing, without com- 
ing in contact with the filter bed. 

6th. Any number of filters may be combined to work in conjunc- 
tion, either to provide greater area for single filtration or to repeat 
the process as many times as desired. 

Tliese filters may be seen in operation in the original plant at the 
Paper Mills of S. D. Warren & Co., at Cumberland Mills, Maine, 
and in the public water works at Brunswick and Augusta, Maine. 



Bovine Tuberculosis. 



By A. G. YOUNO, M. D., Secretary of the Boaid. 



The outbreak of tuberculosis at the State College farm, at Orono- 
in this State, which in tlie spring of 188G necessitated the condemna- 
tion and slaughter by the "Cattle Commission" of the entire herd 
of thoroughbred Jersey and Short-Horn cattle, has drawn attention 
to the insidious character of this disease and the disastrous conse- 
quences which might result from a general distribution of it among 
the flocks and herds of our State. 

The principal facts in regard to this remarkable prevalence of 
tuberculosis in the Orono herd, as given by Dr. Geo. II. Bailey, 
Secretary and Veterinary Surgeon of the Board of Commissioners for 
Maine on Contagious Diseases of Animals, in the Majority Report 
to the Legislature, are as follows : 

Early in March, 188G, Dr. Bailey was called to inspect the College 
herd, which then numbered fifty-one head, and came to the conclu- 
sion that a large proportion of tlie animals was suffering with tuber- 
culosis. 

"The result of subsequent examinations and consultations with 
the State and College ollicials, and finally with Dr. C. B. Michener, 
who was detailed for this service by the Commissioner of Ajrriculture 
at Washington, culminated, as is now well known, in the condemna- 
tion and destruction of the whole herd." 

"At the time of my first visit I found the buildings in which the 
cattle were contained were among the best and most commodious I 
had ever visited, and that every {)roviaion for the maintenance of 
perfect health among its occupants had been fully and amply secured- 
An abundance of sunlight and pure water, scrupulous cleanliness^ 
sufficient and wholesome nutrition, thorough drainage, and ventilatiou 

(219) 



220 STATE BOARD OF HEALTH SPECIAL PAPERS. 

SO perfect that the air was almost as pure inside the barn as out ; all 
contributed to the uniformly fine appearance of this high-bred herd, 
which proved so deceptive (upon further investigation) that, had it 
not been for the persistent and pathognomonic cough, by which they, 
one by one, betrayed their real coudition, I should have much doubted 
the correctness of my decision. The rough coat and arched spine, 
the difficult and labored respiration, the sunken e^'e and pendulous 
-abdomen, witii extreme debility and emaciation, were nearly all absent 
in this herd, the judicious attention to hygiene, and the untiring care- 
taking of their faithful Superintendent, accounting in a great meas- 
ure for the slow but sure development of the disease, a circumstance 
that so long deceived the attendants and College officials themselves 
as to their true condition. Many of the animals were also pregnant, 
and it is a well-known fact that increase of the tubercular growth is 
then held in abeyance, the energies of the nutritive processes of the 
body l)cing diverted to the nourishment and growth of the foetus, 
while after parturition the system is for a time debilitated, and rapid 
•extension of tubercle is favored. Individual members of the herd 
were of great excellence, several cows having 'butter records' of 
sixteen pounds per week, while one hundred and fifty pounds of 
• gilt-edged ' butter was being sold in Bangor market weekly. About 
ten days before my vi.-^it, the Jersey cow l\'t. No 40, V. M., four- 
teen years old, had become so emaciated that she had been killed, 
and lay frozen in the field adjoining tiie stables, and this cadaver fur- 
iiished me with ample opi)ortunity to verify my diagnosis. From 
this cow 1 obtained the lungs, and a cross-section of the pulmonary 
tissue revealed the presence of niunerous yellow tubercles, large 
and small cavities filled with a muco-purulent mass, others with 
<;a8eous material. The lungs presented the identical lesions after- 
wards found in most of the animals at Orono, and of the peculiar 
metamorphosis which tubercles undergo, those of cas(K)us degenera- 
tion aflord the most favorable conditions for infecting the expired 
air of diseased animals. At the time of my second visit, March 
1 2tli, from among ten or twelve cows I had previously ordered isolated 
from the others, I selected two Jersey cows, Princess Alice, No. 44, 
P. M., and Princess Alba, No. 27, P. M. (the latter I then regarded 
as a typical case), and had them destroyed for the post mortem ex- 
aminatif)!). I'rinccss Alba had a temperature of 103 3-5°, marked 
<!maciation, and dullness on percussion over the right lung, while 
auscultation clearly disclosed humid crackling or gurgling rales. 



BOVINE TUBERCULOSIS. 221 

The autopsy revealed an extraordinaiy araount of disease. The 
lung, pericardial, and pleural membranes were loaded with deposit, 
which hung like bunches of grapes, exhibiting a perfect case of what 
is known as •' angleberries." In some parts there was scarcely" a 
remnant of |)r()pcr lung-structure detectable, while others contained 
large tubercles filled with caseous material and also cavities connect- 
ing witli bronchia, whose contents had been expectorated or absorbed. 
The bronchial glands in this case had attained enormous dimensions, 
the thymous weighing several pounds, and altogether the lesions were 
as extensive and varied as in any subsequent autopsy. I shall have 
occasion to speak particularly of this cow again as the dam of the 
'Kent Bull' of Bucksport. The lungs of Princess Alice were 
studded with miliary tubercles scattered throughout them, while the 
bronchial lymphatic glands contained calcified material that grated 
under the knife when attempting to cut it. Mr. Gowell wrote me on 
March 20th : 'There is not a ver}- marked change in many of the 
cattle, but in others, particularly those isolated in the stable, the 
process of ' wearing out ' is going on actively, and every day's 
developments go to sustain my conviction and opinion expressed 
before notifying the Board of Commissioners that the entire herd 
was doomed. Unpleasant as it was, I was forced to recognize the 
truth.' " 

"On April Gth, the Commissioners met with the Governor and 
Council, at Orono, when the herd was again inspected and final action 
recommended at an early date. I then suggested to Governor Robie 
the propriety of requesting the Hon. Norman J. Colman, Commis- 
sioner of Agriculture, at Washington, to send Professor Salmon, or 
some other expert examiner from his office, to consult and advise 
with the Cattle Commissioners, as to the proper disposal of so valua- 
ble a herd. The request was promptly complied with and Dr. Ch. 
B. Michener, Professor of Cattle Pathology and Obstetrics, at the 
American Veterinary College of New York, was detailed for this 
service." 

"Dr. ]\Iichencr arrived April •21st. and on the 22d and 23d, after 
a careful and critical examination of every animal in the herd, it was 
found necessary to condemn them all, when they were forthwith ex- 
peditiously and humanely killed, and the post mortems openly made 
in the presence of the Governor, prominent physicians, stock-owners, 
reporters and others interested, 4ihe autopsies in every instance re- 
vealing the fact that the disease had been correctly interpreted, and 
that every animal presented unmistakable lesions of tuberculosis." 



^22 STATE BOARD OF HEALTH SPECIAL PAPERS. 

The following extracts frotu the post mortem notes are given to 
-show the^ character of the pathological changes which were found. 
Though a few are chosen as having presented points of s^Decial inter- 
-est, the selections are pretty fairly representative of the whole lot. 

(No. 1.) Pansey, I. 

Cyst in centre of left lung. Apex affected, right filled with mil- 
iary tubercles. Age 8 years. 

(No. 2.) Mildred, I. 

Adhesions of both lungs to costal pleura, badly affected. Age 5 
years. 

(No. 3.) llyacinthe, I. 

Both lungs affected. Tubercles in right. Age 4 years. 

(No. i).) Helen Hart. 

Both lungs and mammary glands affected, .so that her milk was 
.tainted. Age 8 years. 

(No. 6 ) Helen's Calf. 

Affected with miliar}- deposits in both lungs. Age 8 months. 

(No. 12 ) Blanch. 

Both lungs badly affected. ''Grapes" (angle-berries) and abscess 
jn right lung. Age 3 years. 

(No. 15.) Tinney's Calf. 

Parotid glands affected, coughed badly, and emaciated. Age 3 
riionllis. 

(No. 16.) Blanch's Calf. 

Glands affected, stiff neck. Age i) months. 

(No. 18.) Edith. 

lioili lungs badly affected, and pleural adhesions to ribs. Age 3 
years. 

(No. 22.) Flossy. 

Lame in left shoulder. Right lung greatly affected with large ab- 
-scess, left lung and bronchial glands also niuch affected. Age 2 
years. 

(No. 27.) Princess Alba. 

Lungs loadcfl with deposit, angle-berries, large abscess and cavi- 
vties, with bronchial glands greatly enlarged. Age 8 years. 

(No. 28.) .Jersey Lilly, L 

Stiff neck, emaciated, and l)ad cough. Age 2 years and 9 months. 

t No. 37.) Clover, J. 

Jioth lungs affected with tuberdes. Age 14 years. 



BOVINE TUBERCULOSIS. 223 

(No. 38.) Clover's IVt 

Slightly affected in left lung, calcareous deposit in Itronciiial inlands. 
j\.ge 2 years. 

(No. 39.) Clover's Pet's Calf. 

Tubercles in l)oth lungs, bad cough. Age 8 weeks. 

(No. 51.) Roan Heifer. 

Glands aflfected, and cough. Age 3 niontlis. 

The investigations which were undertaken b^' Dr. Bailey for the 
■purpose of tracing the origin of the disease brought out the fact that 
•the development of the outbreak had not been so sudden as the pub- 
lic at first supposed. It has transpired that as far back as 187G, ten 
years ago, there were cases of tuberculosis developed upon tlie Col- 
lege farm, and that occasionally since then, animals have died of 
•chronic lung trouble or, having been slaughtered on account of a 
wasting disease, have been found to present the post mortem appear- 
.ances of tuberculosis. Before the notification of the Cattle Com- 
mission, there were thus lost from the College herd seven cows from 
1881 to 18SG. 

Tliis outbreak of tuberculosis at Orono has strongly drawn public 
attention to those diseases which are liable to affect our domestic 
animals, and the interest which has been excited has suggested 
various enquiries to the public mind For the purpose of answering 
some of these questions regarding the special disease under consider- 
ation — tuberculosis — this compilation of facts and opinions is given. 

SYMPTOMS. 

As given by Dr. Bailey, "the symptoms of tuberculosis in cattle, 
in its earliest stages, are sometimes involved in more or less obscur- 
ity. Prominent among these are unthriftiness, with a diminished 
and capricious appetite. The animals are easily fatigued, and have 
a weak and hoarse cough, that is almost diagnostic ; the skin is sen- 
sitive and dry, and the coat staring ; the mucous membranes are pale, 
the digestive organs are weak, and they are prone to tympanitis. 
There is increase of temperature, with a variable pulse. The milk 
is deteriorated in quality, being blue and watery, and contain.^ a 
larger proportion of alkaline salts ; but is less rich in nitrogenous 
matters and fat and sugar, than in health, proving that assimilation 
is defective. In herds predisposed to tubercle they often become 
lame from some unassignable cause, when the post mortem exami- 
nation proves that it is due to tubercular inflammation of a joint. 
Flossy (No. 22. P. M ) was a marked case of this species of lame- 



224 STATE BOARD OF HEALTH SPECIAL PAPERS. 

ness in the College herd If the animal is compelled to walk quickly 
there is labored respiration, which becomes so prominent as to as- 
sume the abdominal character, if the pleura is invaded by disease. 
Nymphomania, or excessive sexual desire, is also frequent, but the 
animal is sterile ; as the malad}' develops, the cough becomes more 
persistent and easily induced, and accompanied by muco-purulent 
expectoration. The animals are apathetic and sluggish in their 
movements. Emaciation proceeds more or less rapidly, extreme de- 
bility ensues, the eyes are sunken and brilliant, the mouth is open 
and drawn back at the angles, the spine is arched and tender, and 
the breath, as death approaches, becomes cadavei'ous and foetid. 
Percussion gives dullness in some parts of the chest, and in others 
the normal resonance, although the members of my profession do 
not possess equal advantages with human practitioners, of free and 
easy access to the chest wall, owing in great part to the thick skin 
and hair of animals, as well as the wide distribution of the 'serra- 
tus magnus' muscle posterior to the scapula — while the sound result- 
ing from the first gentle tap upon or beneath the clavicle in the 
human patient often only too clearly reveals lesions that seal the 
fate of a valuable life. 

"Auscultation reveals an altered respiratory murmur ; it is louder 
in some places than in others, and of a harsh and rushing sound. 
Instead of the normal vesicular murmur, we find the ' dry crackle ' 
which is associated with incipient tubercle, the cavernous or bronchial 
sounds which occur during the passage of air into or out of a cavity' 
in the lung, and the humid crackling or gurgling rales, which are 
pathognomonic of advanced tuberculization, and heard during the later 
stages of nearly all cases of consumption. Large crepitation depends- 
upon the passage of air through liquids, but when pus or liquid 
matter of any kind is collected in a vomica, which communicates 
freely with the trachea through pervious bronchi, the bubbles pro- 
duced by the entrance and exit of air will l)e still more numerous and 
large ; and a sound is then produced which the word gurgling well 
expresses. Whenever, therefore, we hear gurgling during respiration 
or during the act of coughing, wc conclude we have a cavity. 
Another constant accompaniment of progressve phthisis is emaciation, 
and if, without any apparent cause, an animal grows thin and weak, 
with a quick pulse and labored respiration, these indications are 
pregnant with meaning that tubercular disease is at work in the lungs, 
and is consuming life. The detection of the disease is sometimes diffi- 



BOVINE TUBERCULOSIS. 225 

cult. It is eas}' when the tubercles are numerous, large or far ad- 
vanced ; difficult when they are scanty in number, thinly scattered and 
individually small, and in the latter case would not cause an}' appre- 
ciable deviation from the natural resonance of the chest on percussion, 
or from the natural smooth, equable rustle of the breathing. The 
disease always terminates fatally, if the animal be permitted to linger 
on, and it dies in a state of extreme marasmus." 

CHARACTER AND ESSENTIAL NATURE. 

Tuberculosis is a disease which affects many kinds of animals, 
especially such as are subjected to artificial conditions, though cer- 
tain species are more prone to the disease than others. Cattle are 
ver}' susceptible to the disease and so are swine, poultrj', rabbits 
and guinea-pigs. On the other hand, the disease is rare in horses, 
sheep, dogs, cats, and the carnivora generally, though it may be 
communicated experimental!}' to all these animals, and is sometimes 
found occurring in them spontaneously. In the different animals in 
which the disease may occur, the post mortem appearances may be 
very various, — in fact, the pathological characters are somewhat dis- 
tinctive for each species of animal in which the disease occurs, — and 
3'et, in all, the essential pathological element of tuberculosis is tu- 
bercle. Tubercle occurs primarily as gray, or miliary tubercle, which 
consists of minute growths, developed within the tissues of certain 
organs, as the lungs, liver, or spleen, or scattered over surfaces, 
more frequently over those which are covered with serous membrane, 
as the pleura and peritoneum. The nodules in their earlier stage of 
development may be found of the size of millet seed or smaller, and 
may be few or innumerable. These miliary tubercles or " pearls " 
increase in size, and, particularly on the lining membrane of the 
chest and abdominal cavity, they form groups or clusters like bunches 
of grapes, and later many of them become pedunculated. Partly on 
account of the increase in the connective tissue formation, and partly 
by aggregation of the individual tubercles into composite growths, 
masses of considerable size ma}' be found. 

The secondary changes which occur in the tubercular nodules or 
masses are quite different in character and in point of time in dif- 
ferent individuals of the same species and particularly in difrorent 
species of animals. As tiie result of this different behaviour of these 
tubercular growths, the symptoms and course of the disease vary 

15 



226 STATE BOARD OF HEALTH SPECIAL PAPERS. 

mucli. In man the tubercle of the lungs undergoes a cheesy meta- 
morphosis (caseation) and, breaking down, is discharged as a puru- 
lent expectoration ; iu the ape the disease does not long remain 
restricted to the organs primarily afifected, but extends itself rapidly 
over the system, and the tubercular nodules are rapidly transformed 
into a thin, purulent secretion ; in fowls the nodules form somewhat 
dense tumors in which limy or chalk}' deposits are stored up ; in 
cattle the extension of the disease over the organism is often de- 
layed, the process of caseation going on somewhat slowl}', and sim- 
ullaueously there goes on the process of lime deposit (calcification). 
"When, therefore, we cut into the lung of these last-mentioned ani- 
mals in which the tubercles have undergone the secondary changes 
the knife passes through cavities which are filled with this cheesy 
deposit, and the sensation communicated to the fingers in making the 
incision sometimes gives evidence of the calcified deposits. 

IS THE TUBERCULOSIS OF ANIMALS IDENTICAL WITH THAT OF MAN? 

On account of the marked diflTerence in symptoms and course of 
the disease, and in the pathological appearances after death, there 
was for a long time an earnest discussion among physicians and vet- 
erinarians as to whether the tuberculosis of animals, and particularly 
bovine tuberculosis, is the same disease as human tuberculosis. The 
answer to this question we shall reserve until we have answered the 
question 

IS TUBERCULOSIS INFECTIOUS? 

Observations which seemed to indicate the infectiousness of tuber- 
culosis have not been reserved for recent years, and many have been 
put on record in veterinary literature. The following are a few of 
such : 

''At the time (1848) that the views of veterinary authors were 
most crude with regard to the nature of bovine tuberculosis, I had 
occasion to treat the disease upon a farm wluire it had prevailed for 
a long time and caused much loss to the owner. 

''Upon tl»e farm were always kept fourteen milch cows and cattle, 
a bull, and four calves. Of these, (bur head were sold each year, 
and replaced by the same number of calves. The animals sold were 
not always of tiic same age each year ; in one year the two and three- 
year-olds would be sold, in another older cows, and the third some 
of each, according to the fullness of the owner's purse, so that there 



BOVINE TUBERCULOSIS. 227 

were cattle on the farm two, six and twelve years old. Of these 
older animals, I found on m\' first examination two afflicted with a 
rough, dry cough, and with accelerated respiration. As I was aware 
of the constancy with which the disease had prevailed among the 
owner's cattle, it was my advice to get rid of these two as earl}' as 
possible. The advice was followed. The cattle were fattened, and 
upon being slaughtered m}- diagnosis was confirmed. 

"In the meantime ever}' attention was given to the feeding and 
general care of the cattle upon the place. 

"In 1851 I again found two of the cattle that coughed and 
gradually became somewhat emaciated. The attempt to fatten them 
was partially successful in one, but failed in the other. Both were 
killed, and tuberculosis found in them. Four calves were placed iu 
the spring of 1852 with the cattle in the old stable, and four others 
placed where they were taken from. All seemed to be healthy to the 
spring of 1854, when one of the calves, which had become three 
3'ears old and had been placed in the old stable, began to cough. 
The cough was at first very slight, but commenced to increase after 
the heifer had calved. In the following summer it again diminished, 
to augment very considerably in the fall. This animal was put out 
to graze in the spring of 1855, and to my surprise became quite fat ; 
but upon being slaughtered the animal was found to be highly tuber- 
culous. 

"Of the old cattle there still remained a single cow, which we will 
call 'A,' that had always stood next to the above-mentioned animal. 
All the others had been sold and killed, their places having been filled 
b}' new ones. This cow had coughed for a long time ; Init, not 
suffering in condition, she had been kept, as she was a great favorite 
with the farmer's wife, especially as I had not then the slightest sus- 
picion of infection b}' means of the atmosphere. Every animal 
which during this period had stood beside this cow had begun to 
cough after a shorter or longer period, and, as the positions of the 
animals were sometimes changed, it happened that in course of time 
nearly all of them began to have the same suspicious cough. 

"The continued buying, rearing, and selling of cattle went on for 
nine years before I had opportunity to examine the cow 'A,' which 
was then sold to a butcher. The examination of the body and its 
contents resulted in finding it highly tuberculous. The result of all 
m}' experience awakened in mc the suspicion of the transmission of 
the disease from animal to animal, an opinion which was then con- 



228 STATE BOARD OF HEALTH SPECIAL PAPERS. 

sidered ridiculous. I comrnunicated my opinion to the owner, and 
advised his selling off all his cattle and replacing them with new and 
health}- ones from parents and places where the disease was not 
known to exist. My advice was appreciated l\v the owner calling in 
a quack to take ray place. 

"Ou another farm were kept from twenty-four to twenty-six head 
of cattle. In 1864 the owner bought a calf to bring up, the mother 
of which died a few years later from tuberculosis. This calf developed 
very poorly for the first two years of its life ; its neck and head were 
small and long, and its bones very small, so that the whole habitus 
of the animal was cachectic. This animal was killed in the fall of 
1869. In the course of the winter of 1869-70 many of the cattle 
began to cough, and among them two, 'A' and ' B,' so severely 
that ray services were requested. 

"I found all the aniraals in an apparently health}' condition ; only 
the two, A and li, were noticed to cough. By auscultation, I found 
in A a peculiarly marked bronchial I'espiration in portions of the left 
lung. At this lime I knew nothing of the breeding, or the phenomena 
seen in the above-mentioned calf, which had been slaughtered. Dur- 
ing this winter and the succeeding summer the two cattle, A and B, 
besides others, continued to cough. All the aniraals on the farm 
coughed during the winter of 1870-71, except the yearlings and 
some calves tliat were kept in another stable. In the spring of 1871 
the two cows, A and B, began to emaciate so much that it was con- 
sidered advisable to kill them. The autopsy revealed the general 
characteristics of tubercular pneumonia, and tuberculosis of other 
organs. Basing my opinions upon the previously mentioned expe- 
rience, I made no hesitation in pronouncing all the cattle in this 
stal>le that coughed as afllicted with tuberculosis, and advised the 
owner to gradually get rid of them all. On a(;count of economical 
reasons, this was easier said than done, and the owner has never 
since been free from thi.s disease among his cattle. 

"During the period frora 1864-71, tuberculosis has been always 
present among the cattle of this owner, who has lost nineteen head 
from the disease in that time."* 

"Jamm, veterinary surgeon of the arrondissement of Loerrach, 
has published the following observations, which we think worthy of 
notice: — In the territory of Tannenkirch there is a farm called 
Kaltherberg, let for three years to a farmer named Gugelmaier. An 

•Billings. The relation of Animal DlHcaRcs to the Public Health. 



BOVINE TUBERCULOSIS. 229 

average of ten to a dozen cows, some heifers, and a bull are kept ; 
these animals are parth' of the Schwyz and partly of the Simnienthal 
breed, and are all lodged in the same stable. Four years ago this 
farmer bought at Fribourg, where he sells his milk, a gre}- cow, which 
soon began to cough and become emaciated ; consequently it was 
killed, and it was then found to be affected with tuberculosis — {pleural 
and pulmonary — to a very hi<ih degree. Since the purchase of this 
cow, Gugclmaier has lost ten other cattle from this disease, being 
obliged to kill some and sell others. The following is the succession 
of losses in this farm : — 

The first cow. 
The second cow. 
The third cow. 
The fourth cow. 
The fifth cow. 
The sixth cow. 
The seventh cow. 
The eighth cow. 
The ninth cow. 
The tenth cow. 

"In another animal — a fat heifer sold to a butcher — when it was 
slaughtered there were found a small number of tubercles. 

"In all these animals the disease commenced w'illi a slight cough; 
it did not last longer than three months. Pregnant cows generally 
began to cough towards the middle period of gestation ; after calving 
the disease progressed rapidly. It ma}' be added, as an interesting 
fact, that the farmer lost, a year ago, a grown-up son, who died of 
tuberculosis, and that the farmer's wife, for a long t'me suffering 
from asthma, had been recently reported consumptive "* 

The observations of M. Grad, a veterinary surgeon of Alsace, are 
significant. On different occasions, owners had informed Grad that 
they had lost two, three and four animals in the same stall from con- 
sumption, — marasmus, accompanied b^' cough. At first he did not 
attach any importance to these declarations, either because he thought 
the mortality occurring in this way was merely accidental, or was due 
to hereditarincss, which he acknowledges plays such an important 
part in the production of the malady. However, one da}', when 

♦Lyilt in, Fleming and Van Ilertson. The Influeuce of Heredity and Contagion on the Propa. 

gatiou of Tuberculosis. Louden, 1883. 



1880, 


June. 


(( 


Sept, 


a 


Dec. 


1881, 


Sept. 


1882, 


March. 


a 


June. 


(( 


Julv. 


(( 


August. 


(( 


Sept. 


1883, 


January 



230 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

visiting the stables of an extensive farmer at Leinlieim, he was in- 
formed that every year for five years one of the cattle had died from 
phthisis ; 'and what is very curious,' said the farmer, 'this always 
happens in the same stall.' 

''In proof of this, Grad was shown a young cow, which, on ex- 
amination, offered all the symptoms of tuberculosis; such as exces- 
sive emaciation, skin clinging close to the bones, frequent and feeble 
cough, etc. 

"Its value in this condition was from thirty to forty francs. Ac- 
cording to the farmer, the animal had been ten months in the stall, 
and when first placed therein it was in flourishing health ; it was the 
fifth cow that had fallen into the same state in this stall. Grad's 
attention could not but be strongly aroused by this report ; never- 
theless, he expressed his opinion that an hereditary- tendency was 
doubtless the efficient cause in this succession of losses. Such, 
however, was not the opinion of the fanner, and it was at length 
agreed that Grad should choose a cow from another stable and put 
it in his stall as an experiment. With this object a cow three years 
old, and with calf, was selected ; it had every appearance of perfect 
health, had been bred on the farm, had never been unwell, had never 
coughed, and none of its progenitors had been affected with tubercu- 
losis. It was moved into the stall and remained quite well until after 
calving, when a short cough was the first symptom observed. This 
cough increased in frequency, and emaciation gradually set in, with 
the usual cortege of symptoms accompanying tuberculosis distinctly 
marked, so that in about twelve months the creature was only the 
shadow of its former self, and was sold for a trifle, like the others 
which had preceded it in the stall, to the low-class butchers. Grad 
could no longer resist the evidence in support of this cause, this be- 
ing tlie sixth animal attacked with tul)erculosis in the same stall; 
and lie inferred that in all probability the disease had been trans- 
mitted ])y the ingestion of the matters ex[)ectorated by the cattle 
which had previously inhabited the same place. 

"On his recommendation, all the wood work of the stall was re- 
moved, the manger and rack were thorougiily disinfected, and the 
spot left unoccuj)i(!d for a certain time. 

"When the stall was iel)nilt, and again occupied by several ani- 
mals in .succession, tuberculosis made no more victims either in it 
or in other parts of the stable."* 

*01app. I8 ConBumption Contagious? 



BOVINE TUBERCULOSIS. 231 

The following history of an oull)reak of tuberculosis which oc- 
curred at the Willard Asylum, Willard, N. Y., from the Medical 
Record of Jan. 15, 1887, is quoted at considerable lengtli for the 
reason that it is recent and bears man}' points of resemblance to our 
epizootic of tuberculosis at Orono, 

''During the fall of 1883 tuberculosis broke out in an acute form 
in the asylum herd, which consisted of about one hundred head of 
milch cows and fort}' head of 3'oung stock, most of which were of 
Holstein blood, and with the exception of a few head, all were in 
excellent condition and thought to be in perfect health. During the 
summer months, however, a number of the cows were noticed cougli- 
ing, which attracted some attention, but nothing of a serious nature 
was suspected until late in the fall, when those that had been noticed 
coughing began to emaciate, presenting in general a very bad ap- 
pearance ; the hair seemed dead, having lost its gloss, standing 
erect, cleaving from the skin. Their eyes were sunken and pre- 
sented a heavy appearajice. The animals did not move al)out, and 
usually lingered behind on going to and from pasture, and if hurried, 
they seemed exhausted from want of breath. ]\Iy attention was 
called to them, and on examination I found in several cases an en- 
tire absence of respiratory murmur over the greater portion of either 
lung, and where the respiratory murmur was perceptible I detected 
moist rales, and in places tho rales had assumed a resonant char- 
acter, which indicated consolidation. A severe diarrha'a had now 
developed, which was very offensive, and the milk supply had grad- 
ually lessened for several months. Finally, it was thought best to 
kill one of the feebler ones, and ascertain the true nature of the dis- 
ease. 

"Case I. The animal chosen for examination was eight years old, 
of Holstein blood, and one year previously would have weighed 1,200 
pounds. On post-mortem, the animal was found highly tubercu- 
lous, and there seemed to be no organ in the body free from the dis- 
ease. The lungs were voluminous and double their normal weight. 
They were completely adherent on either side, and the left lung on 
section seemed to be one mass of tubercular deposit. Small vomica 
had formed in some places, in other places the deposit was calcified, 
and in still others, cheesy. The bronchial glands were three to four 
times their normal size and degenerated. Numerous tubercles the 
size of hazel-nuts and smaller were found upon either surface of the 
diaphragm, and the liver was found at least three times its normal 



232 STATE BOARD OF HEALTH SPECIAL PAPERS. 

size and contained large masses that would equal in weight several 
pounds. On cross-section it revealed large cavities filled with a 
muco-purulent mass. The bowels were covered with tubercles, and 
in a state of sub-acute inflammation. All of the abdominal organs 
were more or less alTected, also the milk-bag, which contained sev- 
eral large deposits, some of which were calcified, and others softened 
and in a semi-purulent state All of the glands throughout the body 
were enlarged, and in places degenerated. 

"■Case II was that of a Holstein six-years-old, niwch emaciated, 
and sutfering from a chronic diarrhoea. No respiratory murmur was 
beard over the right side of chest-wall except at the apex. General 
enlargement of the superficial lymphatic glands, also of the sub- 
maxillarv and thyroid. Post-mortem examination : Lungs com- 
pletely adherent on either side, and differing in no respect from those 
of Case No. I. The lungs, with the heart and deposit intact, 
were removed and weighed, which weight equalled thirty-nine and 
one-half pounds. Deducting the weight of the normal lung and 
heart intact, we find about twenty-four pounds of tubercular deposit. 
The liver was double its normal size, and on section large quantities 
of muco-purulent fluid escaped ; the mesenteric glands were degen- 
erated, and the bowels were completely studded with tubercles about 
the size of peas. The milk-bag contained one large deposit between 
its two lobes which was calcified. The finding of these two animals 
so badly diseased, there being others that were failing and manifest- 
ing similar SA'mptoms, naturally created a great aTUOunt of anxiety 
on the part of the medical superintendent. Dr. Chapin, who requested 
that I make an examination of the whole herd. On making such 
examination, twenty-four were found manifesting symptoms of the 
disease, besides several that were considered questionable. Finding 
so many diseased, they being the property of the State, it was thought 
best to seek advice from one of our State veterinarians, as to what 
means were best to adopt. Professor Law, of Cornell University, 
was sent for. After making careful examinations of the herd, he 
reported that twenty-six were diseased, and that he considered several 
suspicious, as they manifested some symptoms of the disease, although 
he was unable to detect an3'thing al)norniul on auscultation. He 
advised the killing of all those that were diseased, the isolation of 
all those that were considered doubtful, and a thorough disinfection 
of the 8tal)leK. Having in the herd a (ull-l)l()oded Holstein l)idl, it 
was considered quite essential to kn(;w if he was affected, although 



BOVINE TUBERCULOSIS. 233 

he had not manifested an^' symptoms of the disease. Upon oaroful 
examination nothing abnormal was detected. Professor Law's ex- 
aminations were made March 22, 1884. 

"Many of the diseased animals remained in the herd for several 
weeks, when the herd was again examined by myself. I found that 
those that only a few weeks previous were considered doul)trul had 
now developed positive symptoms of the disease, and still others 
were found that seemed quite suspicious. The bull, at this time, 
appeared to be failing in flesh, but manifested no positive symptoms. 

''On May 22d and 23d, twenty-eight of the most advanced cases 
were killed. On examination all were found affected, but not all to 
the same degree. The organs principallv affected were the serous 
membranes, the lungs, liver, bowels, and the milk-bag in man\' eases. 
A number of them were affected to an equally great degree as the 
two cases I have alread\' reported. Examination was again made of 
the herd on June 10th, and others were found manifesting the usual 
symptoms ; the bull was again examined and it was very apparent 
that he was affected, although he had not manifested any cough, but 
he was rapidly losing flesh. lie was then weighed, and was found 
to weigh 2,45G pounds. He was again weighed on July 10th, and 
his weight was then 2,290 pounds ; and as at this time it was ver}' 
evident that he also was atiected, it was decided to kill him. On 
post-mortem we found a large deposit in the central portion of the 
left lung, and numerous small tul)ei-eles upon the left pleura. The 
bronchial glands were greatly enlarged, and on cross-section were 
found calcified. There were many tubercles upon the peritoneum 
and bowels. The liver in this case seemed free from disease. Upon 
the glans penis were several small tubercles, and in one place it 
appeared as though several had coalesced and had broken down, 
leaving a cicatrix. Had this been ulcerated, one might have thought 
it a soft chancre. 

"Leaving the herd at present, I wish to call your attention to the 
calves that were born (Uuing the winter and spring of 1883-84:. 
Writers tell us that it is not an unusual occurrence for animals well 
advanced in tuberculosis to abort. This seems to be true, as such 
was the case in this herd. I observed that eight calves were pre- 
maturely born, two of which required assistance at birth, as the 
mothers were much exhausted. One of the two that were removed 
was in about the eighth month of gestation. The fa^tus on examina- 
tion was found saturated with tubercles, some of which were as large 



234 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

as peas, and on drawing a knife across them they were found calcified. 
Tubercles were found in the liver, bowels, diaphragm and chest-wall ; 
there being none observed upon the lungs. The mother of this calf 
was killed some weeks afterward, and was found highl}- tuberculous, 
the disease being well advanced to the third stage, or stage of sup- 
puration. 

"No. 2 was from a diseased mother, also in about the eighth mouth 
of gestation. On examination I found the liver, diapln-agm, and 
bowels quite thickly- studded, but the tubercles were much smaller 
than in the preceding case. Of the other six prematurely born, I 
was able to examine only two of them, as the other four had been 
destroyed before I was acquainted of the fact. One of the two, 
however, that I did examine, was found to have a tuberculous liver. 

"During the winters and springs of 1883-84 and 1884-85 fifty- 
three calves were born to the herd, and each one was examined with 
reference to the disease. Twenty-nine of the number were found 
tuberculous in some of the viscera. The greater number of the 
calves were killed within five weeks after birth, and the whole num- 
ber before the expiration of four months. I will only call your at- 
tention to the most interesting cases. One calf killed at the age of 
five weeks was found highly tuberculous. The liver was double the 
normal size and covered with tubercles. On cross section it was 
found to contain a large vomica, filled with at least one pint of fluid 
of a muco-purulent character. Tubercles were also found upon the 
pleural surface of the left lung ; also an extensive deposit in the 
apex of the same lung. The mesenteric glands were enlarged and 
cheesy. The bowels were thickly studded and in a state of subacute 
inflammation. This calf had suffered from a severe diurrha'a for 
several days, and had failed considerably in flesh. 

"The motlier of this calf was killed shortly afterward, and was 
found l)adly diseased. Among the organs affected was the milk-bag, 
which contained a large tuberculous abscess. In this case does it 
seem possil)h.> for tlie disease to have been acquired wholly after birth? 
To my mind it does not seem possible that the disease could have 
developed with sulUcient rapidity to hav(! produced an abscess of the 
liver in kucIi a limited time. However, 1 am of the opinion that the 
intcKlinul lesions were produced, to a great extent, from the milk of 
its mother, as undoubtedly tlie milk must have contained elements 

of the disease. 

"In another calf, seven weeks old, the left lung was adherent to 
the chest-wall at the apex, where there was a large tubercular deposit. 



BOVINE TUBERCULOSIS. 235 

Also there were many small tubercles upon the lungs and in other 
places. The liver and bowels contained many tubercles the size of 
peas, and on cross-section were found in a state of cheesy degenera- 
tion. In the remaining cases the lesions were not as marked, but the 
disease was none the less apparent. 

"You liave now the history of the herd up to June, 1884, and we 
find that nearly one-half of the herd of milch cows has been dis- 
posed of, all that were supposed to be diseased having been killed. 
The remainder of the herd were observed from time to time, and ex- 
aminations repeated every twent}- or thirty days ; and upon each 
examination new cases were discovered, which were immediately 
removed from the herd, as it was thought they could be fattened and 
made use of. 

"The sorting out and feeding continued for several months, and at 
the time of killing many had not gained at all, while others had taken 
on considerable tlesh ; but upon killing only five were found fit for 
use, and four of these were slightl3' diseased in some of the viscera. 

"During tlie spring of 1885 a number of 3'oung heifers, which had 
been kept upon another portion of the farm, were with calf by the 
bull killed in June previously. Before putting them with the old herd 
they were examined, and many of them were found diseased. It 
was deemed advisable to kill them. The calves of these heifers 
were all diseased, the disease in one calf being traced directl}' to the 
bull, as the mother was found unquestionably health}'. The remainder 
of the young herd which had been exposed to the disease were put 
with the remaining portion of the milch cows, and the combined herds 
now numbered about forty head, Tiie examinations were still con- 
tinued from time to time, during the summer and fall of 1885, and 
occasionally one was found manifesting the usual symptoms of the 
disease. This procedure was continued until the spring of 1880, 
when it was thought advisable to feed the remainder of the herd. 
During the past summer, all were killed except ten, which have been 
killed during the past month, and, in nearl}' every case, disease could be 
found in some of the viscera, and some badly diseased, as I will show 
you from specimens that I have here. The specimen that I wish to show 
you is a very interesting one, inasmuch as it shows that one is not 
able, at all times, to tell whether or not the animal is diseased. You 
will observe that the disease, in this case, is confined wholly to the 
bronchial glands, there being no other organs afi'ected — that is, as 
far as I have boon able to determine. Auscultation of the hnijzs in 
this case revealed nothing abnormal, and the superficial lymphatic 



236 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

glands were not enlarged, and the animal had not manifested a cough. 
The bronchial gland, in a healthy cow, is about four or five inches 
long, about one inch wide, and one-half inch in thickness. Here we 
have a specimen, removed from a Holstein cow nine years old, in 
which we find the gland is about ten to twelve inches in length and 
nearly six inches' in thickness. This, on section, we shall find in 
some places calcified, and in others chees}'. I also have other 
specimens here, removed from another case, in which no disease could 
be found except in the glands, and these without apparent enlarge- 
ment. 

"During the winter of 1883 the asylum purchased a full-blooded, 
registered, Holstein bull-calf, from one of the leading breeding firms 
of this country. This bull was kept from the herd until old enough 
for breeding purposes, and then only came in contact with the herd 
as occasion required. Tliis animal thrived until April last, when I 
noticed that he began to manifest symptoms of the disease. He was 
examined at frequent intervals during the summer, and each exami- 
nation confirmed the previous diagnosis. He was killed on Novem- 
ber 10th, last. Previous to being killed he weighed nearly two 
thousand pounds. On post-mortem I found the left submaxillary 
gland enlarged and suppurating, thyroid gland enlarged and calcified 
and several deposits in the left lung about the size of walnuts ; also 
tubercles upon the peritoneum and bowels. The liver, in this case, 
was free from disease. The glands and portions of the lungs I have 
here for your inspection. 

"Tlie only possible objection that could be raised regarding the 
care of these animals was that of ventilation. The stables were 
kept scrupulously clean, being washed out daily, and there were no 
cesspools about the barns or yards. The barns are situated upon a 
side-hill, thus affording the best possible drainage. 

"Their food was of the best of hay, corn fodder, bran, and vege- 
tables. In the spring of 1H84 all of the animals were removed from 
the barns and put in pasture, and open sheds built for their protec- 
tion. 

"During the following winter the animals were confined in the 
barns only during the time of feeding and milking, they being out 
during the day and protected at night by 8heds open on one side. 
Also in the breeding of this herd of stock there was the greatest 
amount of vigilance exerci.sed in order to avoid inl)reeding." 

For the purpose of determining the question of infectiousness, 
much experimental work has been done upon animals by inoculating 



BOVINE TUBERCULOSIS. 237 

them with tuberculous matter, b}- feeding it to them, and by sub- 
jecting them to the inhalation of it. The great majority- of such 
experiments have been successful in communicating the disease to 
the experimental animals, whether the inoculated material was taken 
from human or animal tubercle. Notwithstanding the preponder- 
ance of positive over negative results, the questions involved needed 
for their satisfactory solution some experimental work which has 
been done in the last few years. 

In the early part of 1882 a decided sensation was produced in the 
medical world b}- the publication of a paper which had been read 
before the Berlin Pliysiological Society by Dr. Robert Koch, under 
the title of "The Etiology of Tuberculosis." 

The work of previous experimenters had made it somewhat prob- 
able that the primary cause of this disease was to be sought in a 
micro-organism. Koch had already' distinguished himself by his 
bacteriological studies, and in this paper he announced the discover}' 
of the haciUus tuberculosis. 

The bacillus of tuberculosis may be most convenienth' examined 
with a microscope which gives a magnification of from 450 to 700 
diameters. A considerabl}- lower power will suffloe, with proper 
staining, for diagnostic purposes. Tlie bacillus cells appear as 
slender rods from a quarter to a half of the diameter of a red blood- 
corpuscle, straiglit or curved. They may occur singly or in twos 
and threes, or in bundles. They are formed prett}' uniformly in the 
giant-cells of tubercle, and appear to bear some relation to these. 
The}' are motionless. "With a high enough power, spores may be 
seen within the bacilli, presenting the appearance of clear vacuoles. 
The l)acilli may be cultivated artificially, the best medium for this 
purpose being solid blood serum of ox or sheep, and the most favor- 
able temperature from 37° to 38° C. 

The following summar}' of his experimental work with the bacillus 
of tuberculosis is taken from the Report of the Imperial Board of 
Health of Germany* which was sent out two years after Koch's an- 
nouncement of his discovery. 

A series of experiments was undertaken partly for the purpose of 
studying the results of inoculation with the tubercular products of 
different organs and of diflferent animals. The inoculations were 
made upon rabbits and guinea-pigs, and if death did not occur within 
eight weeks the animals were killed and examined for evidences of 
tuberculosis. The tubercular material whidi was used in these in- 



♦Mittbcilungen aut dcm Kacscil, Gesundheitsunite. 13and II, 1884, 



238 STATE BOARD OF HEALTH SPECIAL PAPERS. 

ocul.itions was in every case examined and tlie presence of the bacilli 
verified. The following are a few of the groups of inoculations, 
showing the origin of the tuberculous matter used and the results. 

No. 1. Miliary tuberculosis of man, grey nodules of pia mater 
very rich in bacilli. Six guinea-pigs inoculated. Five died, one 
killed. All tuberculous. 

No. 2. Miliar}' tuberculosis of man, grey nodules of lung. Six 
guinea-pigs. All became tuberculous. 

No. 8. Phthisical human lung with cavities. Six guinea-pigs. 
All became tuberculous. 

No. 11. Consumptive human sputum. Nine guinea-pigs. All 
became tuberculous. 

No. 13. Consumptive human sputum which had been dried two 
months. Three guinea-pigs. All became tuberculous. 

No. 21. Partially calcified nodules from lung of tuberculous cow. 
Eight guinea-pigs. All became tuberculous. 

No. 22. Tuberculous nodules from peritoneum of ox. Six guinea- 
pigs. All became tuberculous. 

No. 25. Tuberculous caseous pneumonia of swine. Five guinea- 
pigs. All became tuberculous. 

No. 26. Tubercles from lung of rabbit dead of spontaneous tuber- 
culosis. Four guinea-pigs. All became tuberculous. 

No. 27. Tubercles from lung of ape dead of spontaneous tubercu- 
losis. Two guinea-pigs and two cats. All became tuberculous. 

These will show the variet}' of sources from which the inoculated 
material was derived. In all cases the same characteristic symptoms 
were observed during life, and the same tuberculous changes after 
death, whether the inoculated matter had a hun)an or an animal 
origin. The diagnosis of tuberculosis was in every case confirmed 
by a microscopical examination for the characteristic structural ele- 
ments of tubercle, and in every case the bacillus of tuberculosis 
was found, as it had been in the inoculated matter. In all, there 
were inoculated 179 guinea-pigs, 35 rabbits and 4 cats, and in no 
case was the result unsuccessful, — every animal became tuberculous. 

These experiments were i)reliminary to others which were to fol- 
low. Koch iiad found that the bacilli can be cultivated artificiall}', 
and that the V)est medium for this purpose is solid blood serum of 
cow or sheep with or without the addition of gelatine. On this soil 
the growth of the bacilli takes place very slowly and only between 
the temperatures of 30° and 40° C. It is not until eight or ten days 
that the growth appears as little yellowish scales or grains. The 



BOVINE TUBERCULOSIS. 239 

blood senini during the growth of these pure cultures, as the}' are 
called, is not li(juefied. From one of these little scales a new gen- 
eration may l)e started. The scales gradually increase in size and 
consist entiiel}' of bacilli. 

Tlie objections to former experiments had been that in the inocula- 
tions otlior matter than the bacilli had been transmitted, and conse- 
quently, tliat the infective j^ower may have resided iu this other 
material instead of in bacilli. 

By carrying the bacilli through a sufficient number of these pure 
cultures, and then inoculating from tlie bacilli so produced, it seemed 
that tliis ol)jection could be removed. 

Accordingly, in some of these experiments the bacilli derived from 
a ease of phthisis were carried through a series of twenty-six culti- 
vations, occui)ying a period of a year and a half, and tlien from these 
bacilli, twenty-six removes from the original source of the infection, 
guinea-})igs were inoculated, and became tuberculous and died in a 
rather shorter time than after inoculation with the crude material. 
Otherwise than this, the course of the tuberculosis was exactly- the 
same as when the fresh material was used. 

Another line of experiments was a scries of inhalation experiments 
with these pure cultures. A pure culture, the bacilli of which were 
originally derived from a phthisical human lung, and which had been 
carried through twenty-three cultivations during a period of fifteen 
months, was rubbed up with distilled water, and then so far diluted 
that it appeared almost clear. It was then allowed to stand until 
the visible [)articles had subsided, and the upper portion of the 
liquid, wiiich appeared almost perfectly clear, was made use of for 
the inhalation experiments. 

The animals used in the experiments were, for half an hour on 
three consecutive days, confined in a cage and subjected to the spray 
from an atomizer loaded with the above-mentioned fluid. After the 
inhalatiou was finished, the animals were separated in other roomy 
cages and well taken care of. There appeared in some of these an- 
imals, even after only ten days, difficulty of breathing; many of the 
rabbits and guinea-pigs died in the course of from fourteen to twent}'- 
five days. All the other animals were killed at the end of twenty- 
eight days after last inhalation. All of these animals were found 
tuberculous. 

Although rats and mice are very little susceptible to tuberculosis, 
very numerous tubercles of the lungs were found in the animals of 
this kind which were used in these experiments. 



240 STATE BOARD OF HEALTH SPECIAL PAPERS. 

Summing up the results of these inhalation experiments with the 
pure cultures, there were made use of, in all, 217 animals, consist- 
ing of 9i guinea-pigs, 70 rabbits, 9 cats, and 44 field mice, and that 
in no case did an animal so experimented upon fail to become tuber- 
culous. 

At the same time with these, a considerable number of other ani- 
mals were experimented upon exactly in the same way, with the 
exception that inert substances were used in the atomizer. Of these 
none became tuberculous. 

Further than this, we are told that an exceedingly large number of 
trials were made with other pathogenic and non-pathogenic germs. 
Rabbits, guinea-pigs, mice and other animals received these by 
subcutaneous inoculation, b}' injection into the peritoneal cavit3\ 
and also b}' inhalation, but never in an}- of these was tuberculosis 
produced. 

In the three years which have elapsed since the report of these 
experiments was made, considerable other experimental work of a 
similar kind has been done in various quarters, the most ol which is 
confirmatory of the conclusions arrived at by Koch that tuberculosis 
is an infectious disease, that the bacillus tuberculosis is to be regarded 
as the infective agent and the essential cause of the dist^ase, and 
that human consumption, the "pearl disease" of cattle, and other 
forms of animal tuberculosis are identical in their nature. 

now IS TUBERCULOSIS COMMUNICATED? 

"We have already seen that experimentally the disease may be 
transmitted by inoculation, by inhalation, and by ingestion. Evi- 
dentl}' the first method of communi(ration comes into operation but 
very rarely in spontaneous tuberculosis. On the contrary it is 
easily conceivable that by inhalation and by ingestion the opportu- 
nities for receiving the infection are not of so infrequent oc(!urrence. 
In man, the tuberculous expectoration which contains the infectious 
bacilli, as is shown in another paper in this report, retains its infec- 
tious qualities for a considerable time, even when thoroughly dried 
and pulverized. By the inhalation of this pulverized sputum un- 
doulitc'dly a large proportion of the cases of lung tuberculosis in 
the human race is acquired. In the tuberculosis of birds a promi- 
nent characteristic of the disease is the tuberculous nodules of the 
mucous membrane of the intestinal tract. From this source un- 
doubtedly the bacilli are mingled with the feces and when expelled 



BOVINE TUBERCULOSIS. 241 

Upon the grouiul are likely to contaminate the food, which is picked 
up from the same places. This is the most probable explanation of 
the causation of these outbreaks of tuberculosis of fowls which some- 
times destroN's whole flocks. In bovine tuberculosis expectoration is 
scanty, but inoculation experiments with the saliva of a tuberculous 
cow proved to Toassaint that it is possessed of infective qualities. 
Standing as cattle often do nose to nose, and eating from the same 
cribs, and drinking from the same troughs, it can be imagined that the 
chances are many for the infection to be carried over from the sick 
animal to the well by the inhalation of the expired breath, or by the 
ingestion of fodder or drink which has become infected bj- the expired 
air or by the secretions. 

RELATION OF ANIMAL AND HUMAN TUBERCULOSIS. 

In view of the established etiological unity of animal and human 
tuberculosis, the enquiry in regard to the relation of animal and 
human tuberculosis, and especially, the enquir}' as regards the influ- 
ence of the prevalence of bovine tuberculosis upon the public health, 
becomes a question of the greatest interest and importance to the 
sanitary student, and to the people at large. To learn that such is 
the fact we have only to turn to the current medical, veterinary and 
sanitary' literature. The assumption that in various ways this fatal 
disease may be communicated from animal to man and, converse!}', 
from man to animal, opens possibilities of establishing foci of the 
disease in the human race and in animals, hitherto but little thought 
of. The following cases illustrate some of the ways in which tuber- 
culosis may be accidentally transmitted from man to animals or vice 
versa. 

"A woman fifty-eight j-ears old, who had been consumptive for 
several years, kept a pet dog, which for a year eagerly swallowed her 
phthisical expectoration. At the end of six months the dog coughed 
up copious pnrnlent expectoration, and finally became ver}' thin and 
died. The woman obtained another dog a year old and a foot high. 
Although she gave him plenty of milk and meat, he soon evinced the 
same taste as his predecessor. Six months afterwards he also became 
sick, and died at the end of twenty weeks. Both of his lungs were 
found almost entirely destroyed b}' phthisical suppuration." 

The European veterinarians frequenth' cite similar cases, a sample 
of which is given in the following from a French journal.* 

•Revue D'llygienc, 1885, p. 430. 

16 



242 STATE BOARD OF HEALTH SPECIAL PAPERS. 

"A dog which frequently licked up the matter expectorated by a 
young girl who has since died of phthisis succumbed a few months 
afterward to a general tuberculosis, and at the post mortem examina- 
tion the diagnosis was verified. The characteristic histological lesions 
and the bacilli of tuberculosis were found." 

Still more frequently the same journals have narrated the histories 
of the transmission of tuberculosis from man to the flocks in the 
poultry yard. In one case which is given, large numbers of chickens 
in a poultry yard had been dying for a long time and the post mortem 
examinations revealed the bacilli and the characteristic changes of 
tuberculosis. A veterinary surgeon was consulted in regard to the 
cause, and he learned from the proprietor that his daughter had been 
sick with phthisis and had recently died. During the last stage of 
her sickness she had not left her chamber, but the expectorations 
from the spittoon had been emptied within reach of the poultry. 

In another case a farmer had owned a fine flock of poultr}^ but 
lost successively, for two or three months, half a score of fowls young 
or old that had died at an extreme stage of emaciation. At the 
autopsies of some of the last victims extensive tubercular lesions 
were found in the abdominal viscera and a microscopical examination 
revealed the bacilli of tuberculosis. It was learned that on the farm 
there was a workman who, for a time, had presented unmistakable 
symptoms of pulmonary tuberculosis. Little by little this man became 
incapable of doing his ordinary work, and, not to deprive him of the 
means of earning his living, the farmer confided to him the care of 
his poultry 3'ard, which he attended to for five or six months, and 
about three mouths after he took charge of it the fowls began to die. 
The method of contagion appears very simple. The invalid attend- 
ant related with apparent pleasure that his chickens appeared very 
fond of his supplement to their rations when he expectorated. The 
sputa of this patient had been found to contain the bacilli of tuber- 
culosis and there seems no need of looking further for the cause of 
the outbreak of tuberculosis in the poultry yard.* 

"Dr. E. G. .Janeway relates a number of cases of phthisis 
(Archives of Medicine) illustrating its possible contagiousness. 
Among others was the case of a phthisical young man who kept a pet 
dog. He was accustomed to sleej) with the dog nestling in his arms. 
The animal became afflicted with a cough and subsequently died. 

•Ecvuc D'llygienc, 1885, p. 429. 



BOVINE TUBERCULOSIS. 243 

Another dog shared the same fate. A third dog suffered from a cough, 
but its owner died of phthisis and the dog subsequent!}' recovered."* 

"A man in our neighborhood was in the habit of buying all the 
'wasters' he came across — in fact, created quite a trade. The milk 
in every case was used for food purposes. The consequence was 
that several members of the family were attacked with phtiiisis, and 
died. This was discussed at the time as being a strange coincidence ; 
but the pathology of consumption not having the same light thrown 
upon it as it has now, the matter lapsed into oblivion." 

''A cousin of my own was attacked with phthisis. During the 
progress of the disease, it was discovered that two of the three cows 
which her father possessed were suffering from tuberculosis, one of 
which went off as a 'waster.' The girl in question likewise succumbed. 
As the milk from these cows formed her principal diet, it is not 
difficult to imagine that it was the means of generating the disease."! 

The most of the chances for the communication of tuberculosis 
from man to the domestic animals comes from an inconsiderate dis- 
position of the expectoration of consumptives. Without the cor- 
roborative evidence of such cases as the foregoing and in the light alone 
of the experimental work which has been done to determine whether 
tuberculous products may communicate the disease when taken into 
the stomach, it would be rendered highly probable that occasionally 
theeatingof food which has been soiled by the sputum of consumptives 
might give rise to the disease in animals. But the character of the 
reciprocal relations between the human race and some of our domestic 
animals makes the chances very much greater that man should be the 
party to suffer the most frequently in this reciprocity ; and it will be 
easily surmised even by one who has before given this subject no 
thought, that this danger to man comes almost wholly in his food 
supply. That the flesh and milk of tuberculous animals is a real 
danger to mankind is expressed in the opinions of man}' persons 
whose positions and opportunities should qualify tliem to speak with 
autiiority. 

Fleming, the leading veterinar\' authority of England, said, before 
the identity of bovine and human tuberculosis was fully established, 
that '•'there is ever}' reason to view with grave suspicion the use of 
flesh from phthisical cattle, especially if the disease be much ad- 
vanced and the tissues generally are involved. But with more reason 

•Jounial of Coinpnrutivo Medicine ami Siirpcry. April, IS&l, p. 180. 
tComiuuuicatiou to the first meeting of the Nationul Veterinary Association, Loudon. 



244 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

the milk from cows affected with tuberculosis should be prohibited, 
particularh' when given to infants, who mainly reh' upon this kind 
of food for their nourishment, and whose powers of absorption are 
very active. Even if such milk did not possess dangerous infective 
qualities, its deficiency in nitrogenous elements, fat and sugar, and 
the increased proportion of earthy salts, would render it objection- 
able as an article of diet. It has long been known that it was liable 
to pi-oduce diarrho'a and debility in infants ; but though many chil- 
dren fed on such milk have died from general or localized tubercu- 
losis, the part probably played by this food in its production has not 
been suspected. One of the first matters to be taken into consid- 
eration at this point is a reconsideration of the question whether 
bovine tuberculosis is essentially the same disease in kind as th^ 
human form." 

Prof. Walley of the Edinburgh Royal Veterinar}- College says :* 
"As to the use of milk from animals in which tubercle is suspected 
to exist, no two opinions can be held ; its deleterious effect, even 
when exposed to a tolerable degree of heat, has been abundantly 
proved." 

Dr. Albert Johne, of the Royal Veterinary School of Dresden, 
Germany, expresses the following opinion .-f "The milk from tuber- 
culous animals is to be considered as possessing an unquestionable 
infectious character. It must be the duty of the police to put a stop 
to the reckless usage of such milk to babes." 

Gerlach, the late director of the Royal Veterinary Institution at 
Berlin, whose extensive experimental work in this direction emi- 
nently qualifies liim to express an opinion, says :J 

"We have, therefore, not only the right, but the duty, to adapt 
the result of our investigations to questions of public health. They 
point to one cause of tuberculosis in man as being in the food we 
eat." 

Dr. F. S. Billings now in charge of the Bacteriological Labora- 
tory, University of Nebraska, says:§ 

"This question of the specific infection of milk from tuberculous 
cows is no trifling matter ; on the contrary, it is one of life and death. 
How many thousand babies are yearly brought up ou the bottle with 
cow's milk ! 

•The Four Bovine ScourgcB, Edinburg, 1879. 
f.Jr. Cornp. M.-d. and Surjj., Vol. VI, \>. 280. 
I Ibid, p. 180. 
JO|». clt. 



BOVINE TUBERCULOSIS. 245 

All the fond parents ask is, that the milk is from one coiv. This 
guaranteed, the}' appear to feel perfectl}- satisfied. No one seems 
to have thought that a trustworthy and expert guarantee of the hy- 
gienic condition of the cow giving the milk was necessary. We 
make great demands, and get terribl}' excited about the purity of 
our water suppl}'. We spend millions of dollars to keep the foun- 
tains pure, and to prevent all foreign admixtures on its passage to 
us. Is it not as much our duty to examine into the purity of the 
fountains from which comes our milk supply?" 

Experimentally it has been determined that the infective principle 
of tuberculosis resides in the milk of cows which are suffering with 
that disease, and that when fed to animals it may communicate tuber- 
culosis to them. The first experiments of this kind were made b}' 
Gerlach. He says: "Having a cow afflicted with tuberculosis, it 
was resolved to test the question whether the milk from such a cow 
is capable of producing a similar disease in young animals when fed 
upon it." The results of these experiments were partly negative, 
but there were enough positive results to prove that the disease under 
consideration may be communicated through the medium of the milk 
of tuberculous animals. 

Johne* reports 91 feeding experiments with tuberculous milk. 
P>om these were 31 7 per cent of positive results. 

BoUingerj sums up the results of his milk-feeding experiments as 
follows : 3 pigs, 1 positive, 2 doubtful ; 3 calves, 2 positive, 1 died 
prematurely ; 1 lamb, 1 positive ; 2 dogs and 2 cats, negative ; 14 
rabbits, 2 positive, G negative. The milk given to the 6 in which 
nep:ative results followed had been previousl}- boiled. 

Bang J of Copenhagen, in a paper read before the International 
Medical Congress in that city, called attention to the frequency of lo- 
cal tubercular disease in the udder of the cow, and gave the results of 
his experiments in feeding the milk from tuberculous cows, some of 
which were affected with local tuberculosis of the udder and some 
were not. In all cases where the disease had affected the milk-bag, 
the milk communicated the disease to the animals to which it was 
fed, whether it was taken from the half of the udder that was af- 
fected or not. In the experiments with the milk of tuberculous cows 

*Jr. C'omp. Med. and Surg., Vol. VII, p. 94. 

tlbid, p. 93. 

JIbid, Vol. VI, p. 143. 



246 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

which did not have the local udder tuberculosis the results were 
partly positive and partly negative. 

"•Klebs has been successful in producing tuberculosis by giving 
animals milk from those which were diseased, and his experiments, 
therefore, have an extremeh' important bearing. In addition to 
rabbits and guinea-pigs, — creatures which appear to be very suscepti- 
ble to the artificial production of the malady, — he accidently induced 
the disease in a dog by feeding it with the milk from a cow in the 
last stage of phthisis. The results of his experiments led him to 
the conclusion that the use of this milk always produces tuberculosis, 
which commences as an intestinal catarrh, and then assumes the form 
of tubercles in the mesenteric glands ; it afterwards affects the liver 
and spleen, and subsequently the thoracic organs. He asserts that 
Ihe tubercle virus is present in the milk of phthisical cows, whether 
they are slightly or gravely affected ; and that it chiefly exists in the 
serous portion, as when milk has been so filtered as to deprive it of 
its solid particles, the fluid portion appeared to be as active as when 
the malad}' had reached an advanced stage in the animal from which 
it had been procured. 

''He admits that it may produce no injurious effects on vigorous 
subjects, and he has even observed fully developed tubercles to be 
absorbed and disappear after a time. He thinks it probable that the 
virus of tuberculosis ma}' exist in varying proportion in the milk of 
phthisical cows, according to the extent of the disease in them ; and 
he is further of the opinion that the malady may be developed in 
children born without any tendency to it, through the medium of the 
milk of the mother or nurse." 

Besides these experiments which were purposely instituted to de- 
termine whether tuberculosis may be communicated by means of milk, 
many other experiments unintentionally happening might be cited, the 
evidence of which is in the same line. In the outbreak of tuberculosis 
at "NVillard Asylum, an account of whicli is given in this paper, there 
was an unintentional experiment of this kind which was not quoted 
and which read as follows : 

"In proof that the disease may be acquired by the ingestion of 
tuberculous substances, allow me to call your attention to the Asylum 
herd of swine, which numbered nearly three hundred head. These 
animals were kept in different yards. In one the breeding sows ; 
in anotlier the half-grown pigs, and in the third yard, which was ad- 
joining the slaughter-house, were kept the large hogs which were being 



BOVINE TUBERCULOSIS. 247 

fattened. The hogs in this latter pen had access to the ofifal from 
the slaughter-house where a number of tuberculous cows had been 
killed. Later in the fall a number of the large fat hogs died suddenly 
in full strength, and on post mortem were found highly tubc^n-ulous. 
The disease, however, did not present the same pathological conditions 
as in the cows. The disease seemed more especially confined to the 
abdominal viscera and the glandular system, the lungs being rarely 
affected. In those cases that died suddenly I found a tubercular 
peritonitis, to which was attributed the cause of death. During the 
killing season many were found diseased, there being large metastatic 
abscesses in different portions of the body, but more especially in the 
side ; and in the sows the rudiments of the milk bag were often the 
seat of abscess. Also the joints were frequently affected ; many of 
the hogs, both large and small, became lame. During the winter a 
number of them became partially paralyzed in their hind parts. The 
paralysis progressed, and finally they were unable to use their hind 
limbs at all, and for several days three of them moved about, walk- 
ing upon their fore limbs and dragging their hind parts. Slill they 
were fat and seemed to eat equally as well as the others. Finally 
they were killed, and on post mortem the bodies of the veitebrffi in 
different portions of the column were found to have undergone caseous 
transformation. The cord at these points was softened, and in some 
cases completely obliterated. 

"There were three sows in this yard that proved to be with pig. 
They were taken out and put with others in another 3'ard. One of 
these sows, shortly' after pigging, became paralyzed similarly to those 
that I have alread}' alluded to. In about three months her young 
pigs became hollow-backed ; they walked about with their bellies 
touching the ground. Finally they were killed. All were found 
diseased and the bodies of the vertebrse very incomplete!}' formed. 
The other two sows became paralyzed and were killed before pig- 
ging, but unfortunately an autoi)S3' was not held. 

''After the killing of all the swine that had access to the offal, and 
disinfecting the yards, we have since had no more disease in the 
herd."* 

The following interesting case from a German source is quoted 
from Billings : 

"The milk from a tuberculous cow had been used for some time 
in a cooked condition, but the condition of the cow finallj' became 
so bad it was decided to give the milk to the hogs, but uncooked. 

♦Op. cit. 



248 STATE BOARD OF HEALTH SPECIAL PAPERS. 

'•From Ma3' of the same year, the farmer's wife noticed that the 
young pigs (four or five months old) fed upon this milk did not ap- 
pear to thrive well, and as, in the course of a few weeks, three died, 
I was requested to make an examination of the last one. I found 
the same much emaciated. I found a tuberculous peritonitis with 
effusion in the cavit}' of that organ. The lungs and bronchial glands 
were normal ; the mesenteric glands enlarged — on section of the 
same, found them filled with a tuberculous mass ; tubercles in the 
liver. In the course of a few weeks the two remaining pigs of the 
litter also died. I found tuberculosis in one of them, and the owner 
told me that the other, and another of an old litter which was with 
them, and fed on the same milk, were also found tuberculous on be- 
ing examined." 

Johnc sums up the subject of infection from tuberculous milk as 
follows :* 

"Zippelus reports a fatal case of diarrhoea, in a calf with large 
tuberculous ulcerations in the intestines andtuberculosisof the visceral 
peritoneum ; the mother of the calf was slaughtered on account of 
the disease, which she had in a verj' severe form. Aufrecht found 
the liver of a thirty-seven-days-old rabbit to be the seat of an exten- 
sive miliary tuberculosis the mother of which was inoculated with 
virulent material a day after it gave birth to young. Others have 
reported similar results. 

"Such milk has also caused tuberculosis in swine fed upon it, and 
is especially prevalent in North German swine, where tuberculosis is 
also most frequently met with in cows. Observations have been re- 
sorted to where whole families of swine held at dairies and cheese 
factories have gradually perished from this cause. Frequently the 
disease seems to have appeared in the cattle and swine of the same 
form. 

"Dr. Stang in Amcrbach reports a case of tuberculosis in a five- 
year-old child, where no trace of an hereditary influence could be 
discovered, which had been for a long time fed upon warm milk 
taken directly from a cow in which tuberculosis was unquestionably 
proven to exist. 

"Bollinger considers the danger of transmission to human beings 
as being greater from the consumption of tlic milk from such dis- 
eased animals than from that of tiie lU-sh, as the former is more fre- 
quently taken in an uncooked condition, especially by children. The 

♦Jr. Comp. Med. and Surg., Vol. VI. 



BOVINE TUBERCULOSIS. 249 

receptivity of the latter for the injurious influences of food far ex- 
ceeds that of matured individuals. Bollinger even goes so far as to 
assume that the influence which such food has exerted upon babes 
may have too often been attributed to hereditary conditions. He 
also places emphasis upon the general disposition which seems to 
exist in man to tuberculosis. Bollinger seeks further to support his 
position by quoting the frequency with which tubercular phthisis is 
quoted as causa lethalis in human statistics: 30.25 per cent of all 
deaths in Munich, and according to Koch, one-seventh of all human 
deaths, are due to phthisis. 

"Bollinger, however, has failed to notice quite a number of cases 
Of a similar nature : for instance, Deraone, Uffelmann, Ebstein, Her- 
gard, Felizst, have reported such. Zippelus has endeavored to 
gather statistics with reference to the occurrence of tuberculosis in 
cows and in babes. This important subject needs much more de- 
tailed consideration than it has thus far received from boards of 
health. According to Z.'s table, it appears that the death rate 
among children under two jears old, from tuberculosis, is the greatest 
in those regions where meat inspection has shown the greatest preva- 
lence of tuberculosis in slaughtered cattle. 

"Orth also considers the transmission of bovine tuberculosis to 
human beings as possible, both through consumption of flesh and 
milk. Cohnheim and Aufrecht both consider the milk of tubercu- 
lous cows to be a cause of phthisis mesenterica, the primarj- intestinal 
and acute miliary tuberculosis of children. .Semmer adopts Bol- 
linger's views. The transmission of tuberculosis to dogs b}' such 
food speaks strongly for these views, for dogs have as little suscep- 
tibility to this disease as an}* animal. Virchow is inclined to the 
same opinion, though he does not consider that the results of the 
experiments that have thus far been made full}' warrant condemning 
tlie meat of such cattle for consumption, as tubercles have not yet 
been proven to exist in the flesh itself, though the parts infected 
should not be permitted to be sold. 

"Toussaint believes that infection results easier when tuberculous 
material is taken into the intestines than when inoculated subcu- 
taneously. Basing his ideas upon exact experiment, he considers it 
dangerous to feed meat or its juices, either raw or half-cooked, to 
invalids or children. 

""When we carefully consider all the evidence, pro or con, in this 
question, as well as the results of Koch's investigations, which ab- 



250 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

solutely prove the identit}' and virulence of the disease in both man 
and animals, we are forced to the conviction that we can no longer 
doubt the possibility of the transmission of tuberculosis from ani- 
mals to man through the consumption of the flesh and milk of animals 
thus diseased. Further investigations must be made in the most 
exact manner by unquestionably competent persons. Until it has 
been positively demonstrated that such a possibilit}' does not exist, 
we must accept the evidence of Gerlach, Chauveau, Klebs and Tous- 
saint with reference to the transmissibility of bovine tuberculosis, and 
see that the products from animals thus diseased are not sold for human 
food." 

As regards the danger to be apprehended from the use of the flesh 
of tuberculous animals as food, there is not a harmony of opinion 
among authorities. Some hold that the flesh of tuberculosed animals 
should in all cases be condemned as human food. Others, and the 
larger number who have written upon the subject, would permit the 
use of such meat under certain conditions and under what the}- deem 
proper restrictions. 

Gerlach* would not prohibit the use of such meat when the tuber- 
cular formations are strictlj' localized, but would condemn the flesh 
from all animals in which an}- one of the following conditions are 
found: 1. When the lymphatic glands in the neighborhood of the 
tuberculous organs have also become tuberculosed, and therefore the 
extension of the disease has become more general ; 2. When caseous 
degeneration of the nodules has occurred ; 3. When a general dis- 
tribution of tubercle in the body is found ; 4. When emaciation has 
begun. 

Johne, whose views generally are trustworthy in a high degree, 
would not go so far as Gerlach and condemn all carcasses in which 
the lymphatic glands have become involved. 

Most of the legislation on this subject in Europe, and the meat 
inspection which is done under it, lias been founded in accordance 
with views similar to Gcrlach's and Johne's, and no absolute pro- 
hibition of tlie use of the llesh of tuberculous animals is made. 
But it should 1)0 uridcrstood that the words and acts of the veterina- 
rians and law-makers of the older countries have been dictated largely 
bj' motives of expediency and of economy. The scarcity of meat 
as fof)d for the people is severely felt and the price of it is hij^h. 
While the cost of living generally is considerably less than it is in tliis 

•Endcnburg's Real-Eueytlopaedie dcr gesammton Ilnilkmiflr, Vol. V, p. 344. 



BOVINE TUBERCULOSIS. 251 

country, the price of butter, cheese and meat is alwaN's very high. 
Tuberculosis, moreover, is in man}- countries much more prevalent 
than it is with us. Under these circumstances the sweeping condem- 
nation of all carcasses in which tubercular nodules might be de- 
tected is considered too great a curtailment of the food supply. 

The two authors which have been cited do not deny that tuberculosis 
may be acquired by the ingestion of the flesh of tuberculous animals. 
Gerlach fed thirty-five animals with the raw flesh of tuberculous cows. 
Of these eight contracted the disease. Johne gives forty-six ani- 
mals as having been fed with the raw flesh of tuberculous cows. 
13.1 per cent of these gave positive results and SG.O negative. 
These suffice to prove the existence of the danger. 

HEREDITr. 

It is not long since there were ver}' few who doubted that heredity 
is b}' far the most potent influence in the causation of tuberculosis, 
human or animal, but the investigations of the last few years have 
led to a feeling of uncertaint}' as regards the part played by heredity. 
The result of the experimental and other evidence, which conclusive!}- 
shows tuberculosis to be an infectious disease and capable of trans- 
mission both by ingestion and inhalation, suggests the possibilit}- that 
many of the cases of tuberculosis which have been credited to 
hereditary influence have really been cases of tuberculosis acquired 
after birth. 

It has been well shown that tuberculosis is not very often found in 
early bovine life ; in fact, the cases in which it is found in the earliest 
weeks of the life of the calf are very rare, so that when found they have 
been matters of some interest to pathologists and veterinarians. 
Thus, it is recorded that "on March 27th, 1880, District Veterinary 
.Surgeon Butscher of Bruck (Upper Bavaria) showed the tubercu- 
lous lung of a sucking calf at one of the meetings of the Munich 
Veterinary Association." 

In one of the German veterinary journals it is mentioned that a 
tuberculous calf was found in the abattoir of Nuremburg and the 
same journal in the same year reports that there were five tuberculous 
calves killed in the Augsburg abattoir.* lu the latter abattoir under 
oflEicial inspection there were killed in the year 1876, 25,909 calves. 
Of these, one, three weeks old, was found tuberculous. f 

tBillings, Aniiiinl Diseases. 

*Piop«grttion of Tuberculosis, Ljdtin, Fleming and Van Hertsen. 



252 STATE BOARD OF HEALTH SPECIAL PAPERS. 

Id the slaughter-houses in Berlin, 1884-1885. tuberculosis was 
found in 1599 cattle, in 2304: swine, and in two calves. In the 
slaughter-houses of Munich, according to an official communica- 
tion, there were, in the course of several years, 150.000 calves 
slaughtered. Of these not one was found tuberculous. In Munich, 
however, in 1884, one calf was found tuberculous.* 

As infrequently as tuberculosis has been found in the earliest 
weeks in the life of the calf, the authentic reports of cases of bovine 
foetal tuberculosis are still more rare. It was only four years ago 
that one of the most experienced of German pathologists said that 
"there has never 3'et been discovered any trace of tuberculosis at 
an}' stage of foetal development, whether human or animal. "f Pos- 
sibly Klebs went too far with this positive enunciation, for in the 
same year. 1883, we find in the Report on "The Influence of Hered- 
ity and Contagion on the Propagation of Tuberculosis" which was 
made to the International Veterinary Congress of that year, several 
cases of bovine foetal tuberculosis. 

Semmer relates five cases of pulmonary tuberculosis he met with 
in foetuses of cattle. In the first of these cases he remarked several 
small nodules in the lungs of a three-months embryo, aborted by a 
tuberculous cow. These nodules consisted of aggregations of spher- 
ical and fusiform cells, with filamentous ramifications. The second 
case was that of a six-months' fcetus, also aborted by a tuberculous 
cow ; in this foetus the lungs showed numerous white points or 
nudules, some the size of a pin's head. These had the appearance 
of round-celled sarcomata, the cells in some places being so matted 
that the connective tissue appeared to be completely absent ; these 
masses of cells might be considered as the point of departure of a 
tubercular formation. The third case was a fa-tus of eight months, 
from a tuberculous cow ; the lungs contained isolated nodules larger 
than in the two preceding cases, though analogous to them in struc- 
ture. The two last cases were new-born calves from diseased cows ; 
their lungs were full of nodules of various sizes and in different de- 
grees of formation, some being in the earlier stages and others 
already caseified or calcified. 

Jensen found the lungs of an aborted bovine fa'tus, three months 
old, full of recent tubercles. 

As regards these cases there is a chance to doubt the specific char- 
acter of the tubercular nodules ; but Johue of the Dresden school 

*Fort«chritte und LeiBtungen auf dem Gebieteder Hygiene, 1885. 
tEeal Encyclopadie, VoL XIV, p. 134. 



BOVINE TUBERCULOSIS. 253 

has more recently reported one which must undoubtedly be accepted 
as an authentic case of congenital tuberculosis. The fa'tus was at 
the eighth month of development, and the cow, the mother of it, 
was slaughtered and found to be tuberculous. The report says : 
"The histological examination of the hardened tissues confirmed the 
existing views so far as we are justified in speaking of a character- 
istic histological structure in tubercles, and the microscopical ex- 
amination." 

"The characteristic tubercle bacilli were well represented in the 
giant cells and in the tissues of individual noduli in the limits of the 
caseous elements, in the intermediate tissue before the caseous 
passed into the epitheloid elements of the tubercles. In the last- 
named elements no bacilli were to be fcamd. 

The presence of the bacilli in the noduli proved their genuine 
tuberculous character, and that this case is the first known one of 
undoubted foetal tuberculosis." 

While then recognizing the fact that congenital tuberculosis is a 
possibility, but that its occurrence is extremely rare, how are we to 
account for the fact that at a few months later than the "vealing" 
age tuberculosis begins to be not so rax-e a disease as earlier. For 
instance, in Dr. Bailey's post-mortem notes of the Orouo herd. No. 
6 was eight months. No. 15 three months, No. IG nine months, and 
No. 39 two months old. 

Two theories stand ready at hand. According to one there has 
been a congenital transmission of the germs (specific) of the disease 
which have lain dormant for some mouths or some years before the}- 
have given rise to the recognizable lesions of tuberculosis. Accord- 
ing to the other, these cases of late-appearing tuberculosis are ac- 
quired after birth by contagion through infected milk or otherwise. 

In favor of the contagion theory is our present positive knowledge 
that tuberculosis is an infectious disease and may experimentally be 
communicated to animals by ingestion and b}- inhalation. In favor 
of congenital transmission would be the observations, if such have 
been made, that the calves of tuberculous parents when absolutely 
removed from the possibilities of contagion have, nevertheless, be- 
come tuberculous. Authentic observations of this kind have probabh* 
not been made. 

Further than this it may be said that congenital but dela3-ed tu- 
berculosis, though an old idea, is as yet a hypothesis pure and simple. 
Against it, is the deductioD which may be drawn from the thousands 



254 STATE BOARD OF HEALTH SPECIAL PAPERS. 

of experiments in which, whether the bacilli are implanted in the 
system of a living animal or on an artificial ground, or culture me- 
dium, such a thing as a prolonged dormant stage is entirely unknown. 
No matter in what wa}' the bacilli are introduced into the organism 
or culture field, in a short time, in two or three weeks, they begin to 
develop and to bring forth the typical pathological lesions of tuber- 
culosis. That when transmitted congenitall}' the\' should behave 
differeutly requires, in the absence of sufficient proof, a considerable 
amount of credulity. 

Notwithstanding what has been said, it cannot be denied that 
hereditarN' influence or a hereditary predisposition is a considerable 
factor in the causation of tuberculosis. If tubercle as snch or the 
bacillus tuberculosis is very rarely inherited, the structural peculiari- 
ties of the parents, or their lack of vital resistance to the infection 
of tuberculosis may be transmitted. But, even here, it is uncertain 
what part should be credited to this transmissible hereditary predis- 
position and how much to contagion, for as in the human family so 
with cattle, the offspring of tuberculous parents are more exposed 
to the danger of infection than are most other individuals. 

CAUSES OTHER THAN CONTAGION AND HEREDITY. 

Contagion and hereditary influence belong at the head of the list 
of causes of tuberculosis. Tiie others which may be enumerated 
stand in the relation of accessory causes, and consist in a variety of 
circumstances and conditions to which the animals may be subjected 
and which have a tendency to render their systems more assailable 
by the essential cause. 

Climate is not without influence in predisposing to this disease. 
Further than that the nearer the equator is approached the more the 
climate seems to predispose to tuberculosis, and that dampness and 
coldness of soil favor the disease, we arc not ver3' sure of the cli- 
matic causes. It is well known that in some countries and districts 
bovine tuberculosis is very rare, while in others it is very prevalent. 
The causes of these differences are not always strictly climatic, but 
in some cases are due to local differences in the care of the cattle 
and sometimes, probably more frequently, to the introduction of 
contagion. 

''In liuden the affection is most frequently met with in the neigh- 
borhood of large towns ; it is much less common, or is almost en- 
tirely absent, in hilly or mountainous parts. In certain regions 



BOVINE TUBERCULOSIS. 255 

where cattle are kept almost exclusively for breeding, tuberculosis is 
nearly unknown, as in those in which are raised the Hinterwald cat- 
tle (Schonau, Lorrach, and environs), aud in the administrative dis- 
tricts of Pfullendorf and Messkirch. Up to the present time these 
districts have also remained free from contagious pleuro-pneumonia, 
while those which were previously- \nsited by the latter malady are 
the ones that now have numerous cases of tuberculosis occurring in 
them. 

"Contagious diseases in general, and tuberculosis in particular, are 
ver}' infrequent in habitations to which strange cattle are not admit- 
ted, and where vacancies are filled up by the home stock."* 

Other predisposing causes which may be mentioned are ill venti- 
lation of stables, swill and refuse feeding, prolonged and excessive 
lactation, age, and to some extent, breed. 

SIGNIFICANCE OF BOVINE TUBERCULOSIS FROM AN ECONOMIC AND A 
SANITARY POINT OF VIEW. 

Something of the import of the prevalence of tuberculosis amongst 
our domestic animals maj' be gathered from what has already been 
said, and from the following quotations from the words of others 
more may be gathered. 

In Great Britain the loss from the cattle-plague, pleuro-pneumonia 
and foot-and-mouth disease has beenraany millions of dollars, 3-et 
Walley of Edinburgh, in his able work on "The Four Bovine 
Scourges," includes tuberculosis with these three. In his preface he 
says : 

"Those who know nothing of tubercle may question its claim to a 
place amongst what may be called the bovine scourges, but as will 
be seen on studying it, it is a more insidious (and equally deadly) 
foe to the stock-owner than either of the other three diseases," and 
in the chapter on tuberculosis, 

"The insidious nature of tuberculosis has perhaps had much to do 
with the comparative slowness with which professional and public 
attention has been directed to it, but the strides which it has made 
and the hold which it has gained on our stock render it one of the 
most — if not the most — important questions alfecting the future well- 
being of the bovine species. 

"Looking at an individual tubercle we might be led to despise its 
comparative insignificance, and to ignore its deadh- meaning ; but 

♦Lydtiii, Fleming and Vou lleitscn, op. cit. 



256 STATE BOARD OF HEALTH SPECIAL PAPERS. 

when we see thousands upon thousands of these knots existing in the 
organism of a single animal, a truth is forced upon our minds which 
we cannot refuse to recognize — v\7 : that we have to deal with an 
insidious, implacable and deadly foe." 

In the report of the committee on tuberculosis to the International 
Veterinary Congress held in Brussels in 1883, it was said : 

Tuberculosis is, of all the maladies affecting the domesticated 
animals, that which is the most wide-spread, and which, of all others, 
most deserves the qualification of universal panzooty (Weltseuche).'' 

Johne sa^-s : "The carelessness, which in man}- cases might be 
called reprehensible, with which agriculturists have tolerated tuber- 
culosis in their cattle, must be abolished, and the medical and veter- 
inary professions will be compelled to assume a most decided position 
on the question of tuberculosis." 

In a number of the larger German cities where an inspection of 
the slaughter-houses is made, it would seem that about two per cent 
of the cattle killed have been found tuberculous. 

Dr. M. D. Blaine, the reporter of the Willard Asylum outbreak 
says: "During the past two and one-half years I have examined 
over four thousand head of animals in different sections of this State, 
and I find that the disease is more prevalent than is generalij' known. 
The majority of animals that I have examined were milch-cows, and 
I found twenty-one per cent manifesting symptoms of the disease ; 
but perhaps not ov^r four per cent of them manifested pulmonary 
lesions. I have vistted some herds where at least fifty per cent could 
be shown to be tuberculous. The disease seems to be much more 
prevalent in some localities than in others. For instance, in low, 
wet, and marshy districts it is very common ; also in places where 
animals are poorly fed and kept in close confinement, and in poorly 
ventilated stables. 

"I visited your stock-yards during the month of July last, also 
examined a number of herds about your city and Brooklyn. The 
morning I visited the stock-yards at ISOth Street, in company with 
Mr. Romane, one of your meat inspectors, I saw thirteen cows that 
were offered for sale, three of which were badly diseased, and one 
of the three was a cow thirteen years old and manifested pulmonary 
lesion. I acquainted Mr. Romaue of the fact, and when lie consulted 
the rnanag(.'r of the yard in regard to the cattle, he said that tliey 
had been sold to parties in Jersey- City for milkers. I visited herds 
that furnished milk for the city of Brooklyn, and I did not fail to 



BOVINE TUBERCULOSIS. 257 

find tuberculous animals in erery herd that I visited, and in sor^e 
herds to a great degree. But I was astonished in not finding more 
disease than I did, as the manner in which the animals were being 
cared for was not only unhygienic, but cruel, especially in winter, as 
several herdsmen informed me that their animals were tied in tliose 
small barns in the fall, and were not taken out in the open air until 
springtime." 

In his report to the Department of Agriculture, on the contagious 
diseases of domestic animals, Professor Law of Cornell University' 
sa3's that, "twenty, thirty, and even fifty per cent of certain herds, 
that supply New York City with milk, are affected with this disease. 
In some country districts can be shown large herds with ninety per 
cent subjects of tuberculosis." 

This is a report for onl}' certain districts. In this country we 
have no statistics to teach us anything as regards the general preva- 
lence of the disease, but there is reason to fear that it is on the in- 
crease here as Fleming thinks it is in England. This author* said 
ten or twelve 3'ears ago : 

"Recent researches have shown, in the clearest manner, that 
scrofula or tuberculosis — a contagious disease — is very common in 
cattle, and especially in dair\" cows ; and that not onh- will Uie flesh 
of these produce consumption in other animals fed upon it — and 
particularly young animals — but that their milk also will infect. We 
dare not experiment upon human beings, to ascertain whether such 
a terrible result is possible with them, but judging from analogy, we 
cannot venture to doubt it. The flesh and milk of scrofulous cattle 
enter largely into the diet of probably thousands of people every 
year. That contamination maj' take place from the milk is, per- 
haps, the most serious reflection, as this is rarely boiled ; for it has 
been proved that a high temperature will destroy the infective prop- 
erty, and hence the flesh, if thoroughl}- cooked, may be rendere<l 
inert. 

"When we remember that milk is the staple diet of young chil- 
dren, and that infantile diarrhoea and glandular affections of a scrof- 
ulous nature annually carry oflT large numbers, while phthisis in 
young people and adults is a wide-spread and fatal malady, we are 
brought face to face with the serious question as to the share the 

*The Cont«Kiou9 Diseases of Animais. 



258 STATE BOARD OF HEALTH SPECIAL PAPERS. 

flesh and milk of diseased cattle raa}' have in the production of this 
mortalit}"." 

In our State we have good reasons for believing that the preva- 
lence of bovine tuberculosis is less than in most of the other States, 
— probablv less than in an}' other State. Excepting the limited 
extension of the malady from a ver}'^ few infected points, according 
to the best testimon}- which we have, our herds are free from the 
disease. From what has been given in this paper, it is thought it 
may be understood how important it is, both as a question of public 
health and of public wealth, to keep our domestic animals, especially 
our cattle, as free as possible from this scourge. One of the aims 
has been to show how closely inter-related is the tuberculosis of ani- 
mals and of man, — that the general prevalence of animal tubercu- 
losis would be a constant source of danger to the human population, 
and that, from infection derived from human sources, outbreaks of 
tuberculosis may start in our domestic animals. We are therefore 
liable to have fresh outbreaks of bovine tuberculosis the origin of 
which cannot be traced to any other preceding case of animal tuber- 
culosis as long as human pulmonary consumption is the leading dis- 
ease of civilized life. From whatever source derived, and wherever 
found, a strictly administered weeding-out policy should be applied 
b}' State and municipal governments. This should be carried out, 
not only as a humanitarian policy as regards the vital and financial 
welfare of our own people, but also in consideration of the welfare 
of the many thousands who yearly spend the summer months with 
us. They come not onl}^ for the pleasure which may be derived 
from our coast and inland scenery, but many of them in considera- 
tion of the fresh air, pure water, and uncontaminated milk and but- 
ter supply for their children. Many of these summer visitors have 
been in tiie habit of thinking of these sanitary considerations rather 
more than we have until of late, and in studying to promote the wel- 
fare of this transient part of our population, we shall ))est subserve 
our own interests. 

PREVENTIVE MEASURES. 

Any other disposition of tuberculosed animals than by quarantine 
and speedy slaughter would be a serious error. The following regu- 
lations given by Johne for stamping out the disease are in accord with 
the views of all intelligent veterinarians. 



BOVIXE TUBERCULOSIS. 259 

"All tuberculous or animals with tubercular or tendencies to pul- 
monary diseases must be unconditionally excluded from breeding. 

"All animals diseased with tuberculosis must be unconditionally 
separated from health}' ones, and immediately slaughtered. Sus- 
pected ones should be treated in the same manner. 

"Stables in which such animals have been kept must be thoroughly 
cleansed and disinfected. 

"All momenta tending to produce a predisposition to disease must 
be carefully avoided, and great care given to ventilation, diet, ex- 
ercise, exposure, etc." 

In connection with preventive measures it may be said that some 
authorities would permit the use of the milk and meat from tuber- 
culous animals provided that previous to its use it be subjected to a 
sufficient degree of heat. As regards milk, there can be no question 
that boiling is destructive to the vitality of the bacilli which may be 
present in it. Bang has concluded from somewhat recent experi- 
ments that milk which is kept at the temperature of 72° C. i, 161.6° 
F.) for a quarter of an hour is sterilized and made harmless. 
The sterilization of the milk so treated was tested only on two 
rabbits. Koch, on the contrary, affirms that the degree of heat fatal 
to the bacillus of tuberculosis is not reached below the boiling point. 
Recenth- Professor Sormani* has communicated the results of his 
experiments in the same direction. He mixed fresh tuberculous spu- 
tum with milk and subjected it for ten minutes to temperatures of 
70°, 80°, and 90° C. Another portion was brought to the boiling 
point. On the 41st day after inoculation all the animals so treated 
with these specimens were found tuberculous. The results were 
very different, however, when the milk was maintained at the boil- 
ing point five minutes, — the animals then remained sound. 

As regards the effect of cooking upon the bacilli in the flesh of 
tuberculous animals, we have some experimental work which gives 
some data. Liebig was the first to attempt to determine the tem- 
perature which was required to cook the interior of pieces of meat. 
According to him, when in the interior of such masses a temperature 
of 70° C. (158° F.) has been reached the flesh is fully done, so that 
it has lost its red appearance. Perroncito found that when consid- 
erable masses of flesh were cooked for three hours the interior never 
reached a higher temperature than 84° C. (183.2° F.) Woltfhugel 

•Revue D'llygicnc, 1S86, p. 430. 



260 STATE BOARD OF HEALTH SPECIAL PAPERS. 

and Hueppe learned in their experiments* that, in the process of 
either baking or boiling large pieces of meat, the heat penetrates 
ver}' slowly and that it never reaches, even after several hours cook- 
ing, 100° C. (212° F.) in the interior of the mass and only very rarely 
reaches this temperature even in the superficial parts. 

* Mittheilungen a. d. Kaestd Gesimdheitsamte, Vol. I, p. 399. 



A Comparative View of Sanitary Laws, and What 
Changes are Needed in Those of Maine * 



By A. G. Young, M. D., Secretary of the Board. 



An examination of the public liealth laws of the various English- 
speaking peoples shows unmistakably in many directions the mould- 
ing influence of the few earlier models of this kind of legislation. 
It shows also among the laws many points of difference and various 
degrees of excellence. A law has been defined by some of our jurists 
as the expression of a want. These wants which have found utter- 
ance in the language of our statute books it is quite conceivable have 
not been found to be the same over the whole length and breadth of 
the many degrees of longitude and latitude. As the want has differed 
so shall we find the expression of the want to be dissimilar. But 
more frequently, undoubtedly, the dissimilarity in our sanitary enact- 
ments has been due to other causes, — to the slighter or more careful 
stud3' which the makers of legislative bills have given to the needs 
of the State, to the differences in composition of legislatures as far 
as intelligence regarding sanitary matters is concerned, to the more 
or less advanced state of preparedness of the general public for im- 
proved sanitary laws, and often, undoubtedly, to the correct or incor- 
rect appreciation of the state of the public mind, by makers of bills 
or legislative enactors of them. 

In a few of our States there has lately been an attempt to codify 
and improve the scattered enactments and to make the laws more in 
conformity with the clearly felt needs of modern sanitation, and some 
of these it is a pleasure to read. 

But in most of our States the existing legislation is well character- 
ized by the expression "tumbled up;" it has been done piecemeal, 

•Read before the Third Aunual Meeting of the National Conference of State Boards of 
Health, Toronto. 

( 261 ) 



262 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

and in almost all directions there is a reverential clinging to antiquated 
forms which in this age, for eftectiveness and utility, are as much out 
of place as is the wooden plow of our Aztec neighbor. 

In mv own State, which was originally a part of Massachu- 
setts, the public health laws were copied largely from those of 
the mother State. For instance, almost everything which we have 
relative to the important matter of the management of the contagious 
diseases we got from an act approved March 10th, 1821, entitled 
"An act to prevent the spreading of the Small-Pox, and other Con- 
tagious Diseases." This was copied without change from the Mas- 
sachusetts law of that time, and this Massachusetts law was passed 
by the General Court of the Commonwealth June 22d, 1797. 

Furthermore, a large part of this Massachusetts law was a trans- 
cript of the old Colonial law. In an act passed one hundred and 
eighty-five j'ears ago, in the reign of William the Fourth, we read : 

"Sec. 3. That, if need so require, an\' two justices of the peace 
may make out a warrant, directed to the sheriffe of the county or his 
deputy, or constables of the town or place where any such sick per- 
son or persons shall be, requiring them or any of them, in his maj- 
esty's name, with the advice and direction of the selectmen of the 
same, to impress and take up convenient housing, lodging, nurses, 
tendance and other necessaries for the accommodation, safety and 
relief of the sick." 

This venerable law, handed down from the early colonial times to 
the newl}' erected Commonwealth, and by her in later 3'ears be- 
stowed as a part of the legal dowry of our own State, where it remains 
intact, is a fitting testimonial of the sterling good sense i)osses.sed 
])y our early legislators and may be deemed a reflex of the sanitary 
knowledge and of the methods in those times of dealing with con- 
tagious rliseases and the question of quarantine ; but standing as it 
now does, without amendment and without change, save to be shorn 
of its antiquated phraseology, it is a sorry index of the needs of this 
latter half of the current century and a very inefllcient piece of legal 
machinery for dealing with many of the sanitary problems as they 
now present themselves to us. 

In the f(;llowing very incomplete comparative view of the health 
laws of some of our States, together with those of England and the 
Province of Ontario, the presentation will mostly be made under 
four separate heads, viz : 



A COMPARATIVE VIEW OF SANITARY LAWS. 263 

State Boards of Health, 
Local Boards of Health, 
Nuisances and 
Contagious Diseases. 

STATE BOARDS OF HEALTH. 

A marked difference exists in the various State or central boards 
of health in regard to their powers and duties. The role of some of 
them, as defined b}' the legislative acts establishing them, would 
appear to be hardly more than educational and advisory. Ex- 
amples of such boards with restricted executive powers are those of 
Maine, Rhode Island, Connecticut, Indiana, and Michigan. Some 
of these, notwithstanding their limited jurisdiction, have done excel- 
lent sanitary work. 

To other boards their legislatures have delegated a certain share 
of law-making power, thereby under certain circumstances or in 
certain emergencies increasing their effectiveness and usefulness. 
The law of Illinois defining the powers of the Board says that it 
"shall have authorit}- to make such rules and regulations and 
such sanitary investigations as they may, from time to time, deem 
necessarj' for the preservation or improvement of public health ; and 
it shall be the duty of all police officers, sheriffs, constables and all 
other officers and employes of the State, to enforce such rules and 
regulations." 

•'Under this section," says the Attorney-General, broad duties 
devolve upon the State Board of Health, and ample power is given 
to enable them to discharge their duties. The}- not only have the 
right, but it is their duty, to make any and all rules and regulations 
which they deem necessary to preserve the public health. Sucli 
rules and regulations, when promulgated, have the force and author- 
ity of law, and are to be enforced, if necessary', by the entire power 
of the State." 

The same powers are given to the Iowa Board in the same words, 
and by a recent enactment similar powers have been granted to the 
New Hampshire Board. In Arkansas "At any time the Governor 
of the State may require the State Board of Health to examine into 
nuisances or questions affecting the security of life and health in any 
locality, and in such case the said board shall have all necessary 
powers to make examinations and shall report the results thereof to 



264 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

the Governor." In accordance with the report of the Board the 
Governor may declare the matter or thing under consideration a nui- 
sance and is granted the necessary powers to have it changed, abated 
or removed. New York in 1882 adopted the same as an amendment 
to her law. 

In England the powers and duties of the Local Government Board 
are various. It acts in man}' cases as a board of appeal ; the by-laws of 
the local authorities must be submitted to it for approval ; it may from 
time to time make, alter and revoke regulations for the prevention of 
contagious diseases ; it may require any two or more local authori- 
ties to act together, or for various purposes ma}' form two or more 
districts into a united district, or may unite two or more districts 
for the purpose of appointing a medical officer of health ; it may, 
by provisional order, dissolve an}' local government district or merge 
it into some other urban or rural district ; it may invest a rural 
authority with the powers of an urban authority ; it may order and 
compel the local authority to undertake and contract to clean streets 
and remove and dispose of garbage ; it may, when a local author- 
ity is in default in performing its duty, make an order and enforce it 
by writ of mandamus if necessary, or appoint an agent to do the 
duty. 

Some of our American State and provincial legislatures have done 
well in drawing freely from some of the better parts of the English 
law. Minnesota and Ontario have adopted with slight changes the 
following from the English law. "Whenever any part of England 
appears to be threatened with or is affected by any formidable epi- 
demic, endemic or infectious disease, the Local Government Board 
may make and from time to time alter and revoke regulations for all 
or any of the following purposes ; (namely), 

(1.) For the speedy interment of the dead ; and 

(2.) For house-to-house visitation ; and 

(S.) For the provision of medical aid and accommodation, for the 
promotion of cleansing, ventilation and disinfection, and for guard- 
ing against the spread of disease." 

Among other commendable points in some of the laws establish- 
ing American boards may be mentioned the power, as far as it may 
l)e conferred by State legislative authority, of inspecting and if 
necessary detaining steamboats, railway trains, and other convey- 
ances when noc(!SHitatcd l)y the existence of contagions diseases, as 
in Ontario, West Virginia and New Jersey ; of appointing sanitary 



A COMPARATIVE VIEW OF SANITARY LAWS. 265 

police, as in Ontario ; of appointing inspectors and assigning them 
'•to such duties as the interests of the public health in an}- part of 
the State may require," as in New Jerse}- ; of ordering "nuisances, 
or the cause of any special disease or mortality, to be abated and 
removed," as in Pennsylvania; the appropriation of an epidemic or 
emergenc}' fund, as in New Hampshire, Connecticut, New Jersey-, 
Maryland, Minnesota and Illinois ; the giving to the State Board 
local jurisdiction co-ordinate with the powers of the local board when 
infectious diseases exist, as in Massachusetts ; and the investing of 
the State Board with the powers of justices in making examina- 
tions, as in Minnesota and Ontario. 

LOCAL BOARDS. 

In regard to local boards of health there is the question of the 
unit of local administration. Some contend it should be the 
town or township, others that it should be the county. For some of 
the States county boards alone would be manifestly inappropriate 
when we take into consideration the size of some of the counties. 
In the State of Maine there are counties 125 or 130 miles in length, 
and one with an area almost large enough to make one Connecticut 
and two Rhode Islands. 

There are various other questions which are of practical impor- 
tance in forming local boards, and which have been answered very 
differently by the laws of different States. 

What shall be the number of members on the board? 

England answers b\- letting the Local Government Board deter- 
mine in each case. 

In Ontario the number in townships or incorporated villages is five ; 
iu towns with a population less than 4000 it is live, if more than 
4000, nine. 

In Maine and Massachusetts three to nine. 

New Jersey has five to seven. 

Delaware three to seven. 

Illinois three on township boards. 

Michigan four. 

New York, in cities, seven ; villages, three to seven. 

California five, and in Pennsylvania iu cities, the same. 

Minnesota not less than three. 



266 STATE BOARD OF HEALTH SPECIAL PAPERS. 

Who shall constitute the board ? 

In England this depends largely upon property qualifications. 

In Rhode Island, Indiana, lUinois, Michigan and Iowa the mu- 
nicipal officers constitute an ex-officio board, and in Indiana and 
Kansas the County Commissioners form an ex-officio county board. 

In Maine and Massachusetts, when the town fails to elect a board, 
the municipal officers are the board. 

The board consists in Connecticut of the justices of the peace and 
the selectmen. 

In New York, in cities and villages the board shall not be ex-officio, 
neither shall any of the members be connected with the city council, 
or on the board of village trustees. In towns the supervisor, jus- 
tices of the peace, town clerk, and one elective member. 

In Delaware there shall be at least one physician, and, when there 
is a port physician, he shall be an ex-officio member. 

In Ontario, in townships and incorporated villages the reeve, clerk 
and three rate-payers ; in towns of less than 4000, mayor, clerk, and 
three rate-payers ; in city or town of more than 4000, the mayor 
and eight rate-payers. 

In Pennsylvania, in cities the mayor as ex-officio president, and 
four appointed members ; in boroughs, the council forms an ex-officio 
board. 



How shall the board be chosen, by election or by appointment? 

We find it is by election in England. 

In Maine and Massachusetts it is by election in town meetings in 
towns ; in cities the board of health is appointed by the municipal 
council. 

In New York in cities, appointed by council upon nomination by 
mayor ; in incorporated villages, appointed by trustees ; in towns the 
one elective member is elected by the ex-offiicio members. 

In New Jersey, Pennsylvania, Delaware and California appointed 
by the common council. 

In West Virginia, nominated by the county court and appointed by 
the State Board. 

Shall the choosing of the board Ije optional or obligatory? 

Outside of the States which have ex-officio boards the law of Ontario, 
New York, Delaware and West Virginia says shall. In Maine, 
Massachusetts and Pennsylvania it says maij. 

In Tennessee it says shall for every municipality of 5000 or over. 



A COMPARATIVE VIEW OF SANITARY LAWS. 267 

What provision or penalty other than providing for an ex-officio 
board when a board is not chosen ? 

There is none in most of the States. 

In Ontario the Provincial Board may appoint the appointive mem- 
bers. 

In New York the board is appointed b}' the county judge. 

In Pennsylvania the State Board may act. 

In West Virginia vacancies ma}' be filled by the State Board upon 
nomination of the county' court. 



What shall be the term of office ? 

The law says one year in Ontario, Maine, Massachusetts, Delaware, 
Minnesota, and in villages and towns in New York and in the States 
having ex-officio boards. Two years in West Virginia and Pennsyl- 
vania. 

Three years in England, Ohio, and In the cities of New York, 

In New Jersey it shall not exceed four years. 

In California, at the pleasure of the appointing power. 



How man}' members shall retire yearly' ? 

In Ontario, Maine, Massachusetts and in the States having eX' 
officio boards, the whole board retires annuall}" in most cases. 

In E^nglaud as nearly as ma}' be one-third shall go out of office 
yearly. 

In New Jersej' in cities of more than 100,000 inhabitants not 
more than three. 

In Ohio two. 

In New York and Pennsylvania, in cities, two. 



What provision or penalty when the board makes default of duty? 

In England the Local Government Board shall make an order 
limiting a time for the performance of their dut}'. Then if not done, 
it may be enforced by a writ of mandamus, or the Local Govern- 
ment Board may appoint some person to perform such duty. 

In New York the performance of the duty ma}' be enforced b}' a 
writ of mandamus at the instance of the State Board of Health, its 
president, secretary or any member thereof. 



268 STATE BOARD OF HEALTH SPECIAL PAPERS. 

In Pennsylvania "The State Board of Health shall have power 
and authority to order nuisances or the cause of any special disease 
or mortality to be abated aud removed," etc. 

In Minnesota "any member of any board of health or health offi- 
cer, who shall neglect to perform the duties required of him under 
the provisions of this act, or any other acts relating to the duties of 
the boards of health or health officers of this State, or who shall 
neglect or refuse to obey any reasonable directions as to infectious 
diseases as shall be directed by the State Board of Health, shall be 
liable, upon conviction in any court having competent jurisdiction, 
to be fined in a sum not less than twenty-five ($25) dollars nor more 
than one hundred ($100) dollars, and shall become disqualified from 
holding the office of a member of the Board of Health." 



By whom shall the local rules, regulations or by-laws be made? 

In England b^' the local authority and approved by the Local 
Government Board. 

Ontario, made by the Legislative Assembly and in force in ever}' 
municipality till altered by the municipal council. 

Maine, except in cities, must be adopted by the towns in open town 
meeting. 

New Hampshire, made by health officers and approved by the se- 
lectmen. 

In Pennsylvania by the board of health, when the necessary pow- 
ers are granted by the council. 

Indiana by the board under the direction of the State Board. 

In most of the other States this power lies with the local board. 

NUISANCES. 

When an unsanitary condition or nuisance comes under the cogni- 
zance of the local authority a preliminary notice to abate is usually 
served, although not always a legal requirement. In regard to the 
farther proceedings the law says : 

In Ontario, Maine, INIassachusetts, Delaware, Michigan, Iowa and 
most of the other States that the local board shall or may abate at 
the expense of the owner. 

In New Jersey may al)ate in a summary manner, or file a IMll in a 
court of chancery for an injunction. 



A COMPARATIVE VIEW OF SANITARY LAWS. 269 

The provisions regarding the important matter of the resulting 
costs and expenses of abatement are in the English law that the 
"costs shall be deemed money paid for the use and at the request of 
the person on whom the order is made. The costs may be recovered 
in a summary manner, or in any county or superior court. Costs 
recoverable from owner may be recovered from the occupier, to be 
deducted out of the rent. The court shall have power to divide 
costs, expenses and penalties." 

In Ontario the board may recover costs by action or distress. In 
ease of the non-payment thereof the same shall be recovered in like 
manner as municipal taxes. 

In New York the board may sue and recover costs of abating. K 
the execution is not satisfied the judgment shall be a lien upon said 
premises having preference over all other liens or incumbrances 
whatever. 

In New Jerse}' the board shall have the right to recover by action 
of debt the expenses incurred, or "if it shall be deemed inexpedient 
to bring such suit thej- may present a bill to the local municipal au- 
thorities and such bill shall be paid by the municipal government." 

In Illinois the board shall cause suit to be brought under the crim- 
inal code. 

In Iowa costs to be recovered by civil action in the name of the 
State. 

Regarding the power of entry to examine or abate nuisances, the 
law of England says, "The local authority or any of their officers 
shall be admitted. If admission is refused any justice may issue an 
order of admission." 

This is generally the law in our States, excepting in some it is said 
that the justice shall issue his writ. 



In case of default of duty of the local board, what redress for the 
individual or the community against nuisances? 

In England the individual may make complaint to a justice. The 
Local Government Board may authorize any officer of police in the 
district to abate. 

In Ontario the Provincial Board may investigate and, if necessary, 
abate. 

In Massachusetts appeal may be made to the county commissioners. 

In New York the State Board may make an order and enforce it. 



270 STATE BOARD OF HEALTH SPECIAL PAPERS. 

In Pennsylvania, may be enforced b}' the State Board. 
In Maine ''any person injured may maintain an action on the case 
for his damages." 

CONTAGIOUS DISEASES. 

An examination of modern statutory enactments for the prevention 
and restriction of the contagious diseases will show that, as can be 
found in the laws of a century ago, there is pretty unifornih' provis- 
ion of some kind made for the notification of the arrival or existence 
of an infected case, for isolation in hospital or otherwise, and usually 
the imposing of certain obligations upon householders and physicians. 

We do not, however, so frequently find the law taking cognizance 
of many other things which the modern health officer knows is often 
indispensable to success. 

For example, the laws of many of the States are deficient in pro- 
visions regarding the nurses and attendants upon the sick and the 
danger of their transporting infection to others. The law of Ontario, 
however, is explicit on this point. 

"Except the attending physician or clergyman, no person affected 
with small-pox, scarlet fever, diphtheria or cholera, and no person 
having access to any person affected with any of the said diseases 
shall mingle with the general public until such sanitary precautions as 
may be prescril)ed by the local board or attending physician shall 
have been complied with." 

So is the Minnesota law excellent in this direction. 

Provisions for the restriction of the movements of persons and 
things, generally, for the purpose of preventing the transmission of 
contagion are virtuallj' absent in some of the States but in other 
directions the laws are commendable. 

P^ngland has this : 
"Any person who — 

(1.) While suffering from any dangerous infectious disorder 
wilfully exposes himself without proper precautions against spread- 
ing the said disorder in any street, public place, shop, inn or public 
conveyance, or enters any public conveyance without previously no- 
tifying to the owner, conductor, or driver thereof that he is so suf- 
fering ; or 

(2.) Being in charge of any person so suffering, so exposes 
such sufferer ; nhall hv. liable to a penalty not exceeding five pounds ; 
and a person who, while suffering from any such disorder, enters 



A COMPARATIVE VIEW OF SANITARY LAWS. 271 

any public conveyance without previous!}' notifying to the owner or 
driver that he is so suffering, shall in addition be ordered by the 
court to pay such owner or driver the amount of any loss and ex- 
pense they may incur in carrying into effect the provisions of this 
Act with respect to disinfection of the convej'ance." 

Maryland has this section of the English law, and the following 
admirable one appended to it : 

"An} person, parent or guardian or other party, who carelessly 
carry about children or others affected with infectious diseases, or 
who knowingly or wilfully introduce infectious persons into other 
persons' houses, or permit children under their care to attend any 
school, theatre, church or any public place where they will be brought 
in contact with others, shall be liable to a penalty not exceeding one 
hundred dollars for each and every such offence." 

Michigan and Minnesota have also excellent provisions in this 
direction. 



Disinfection is by no means a new word, yet it is too modern to 
be found in the law of some of the States. 

The law of Maine (Chapter 14, Section 0) speaks of "purifying" 
infected articles, but whether this shall be with the mild methods of 
the washerwoman or by the more effectual germicidal processes the 
law does not say. 

The English law says on this point : 

"Where any local authority are of opinion, on the certificate of 
their medical oflicer of health or of any legally qualified medical 
practitioner, that the cleansing or disinfecting of any house or part 
thereof, and of any articles therein likely to retain infection, would 
tend to prevent or check infectious disease, it shall be the duty of 
such authority to give notice in writing to the owner or occupier of 
such house or part thereof, requiring him to cleanse and disinfect 
such house or part thereof and articles within a time specified in 
such notice." 

Ontario and Maryland have adopted this section, and so has Minne- 
sota, with an improvement including buildings, cars, vessels and 
vehicles in the same provision. 



Satisfactory regulations regarding infected clothing are not found 
on the statute books of most of the States. 



272 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

In England "Any person who gives, lends, sells, transmits or ex- 
poses, without previous disinfection, any bedding, clothing, rags or 
other things which have been exposed to infection from any such dis- 
order, shall be liable to a penalty not exceeding five pounds." 

It is further provided that "any local authority' may direct the 
destruction of any bedding, clothing or other articles which have 
been exposed to infection from an}' dangerous infectious disorder, 
and ma}' give compensation for the same." And "any local author- 
ity ma}' provide a proper place, with all necessary apparatus and 
attendance, for the disinfection of bedding, clothing or other arti- 
cles which have become infected, and may cause any articles brought 
for disinfection to be disinfected free of charge." 

Ontario, Maryland and Minnesota have the same or very nearly 
the same. 



Particularly praiseworthy is the law in England, Ontario and Mary- 
land regarding infected rooms and the liabilities of those who let 
them without adequate disinfection, and regarding infected vehicles 
and the requirements for their disinfection. 



In the laws of Maine there is nothing to protect the public from 
the danger of infection in the burial, disinterment and transportation 
of the bodies of those dead of infectious diseases. 



Commendable features of the law of Massachusetts and Michigan 
are provisions for the protection of schools from the contagious dis- 
eases. 



What I have said I have called "A comparative view of sanitary 
laws and what changes are needed in those of Maine." As a com- 
parative view of the subject, it is very imperfect for not including 
the laws of all the States, and probably for frequent errors and mis- 
apprehensions. 

As treating wholly of statutory laws in contradiction to provisional 
rules and regulations made by virtue of delegated legislative power, 
it does an injustice to certain States, particularly to Illinois, whose 
sanitary laws are largely of this kind. The object has not been to 
teach but to suggest, with the hope of learning from the resulting 
discussion regarding the changes needed in the laws of Maine. 



Healthful School-Rooms. 

From a paper roail Ix-lbrc tlic Maine Peihigoj,'ical Society, Dee. 'M, IS^C, \ty Dr. J. O. Webster 
of Aufrustrt, member of the Board. 

It is neodless to argue the importance of school hysjiene ; it is self 
evident that the places in which our children spend so much of their 
time, in the formative and most susceptible period of life, should be 
in that condition most conducive to health ; that iiowever heavy a 
burden of unhygienic arrangements they have to bear at home, this 
burden should be lifted during the period in which they are under 
the authority of the commonwealth. 

The three most important factors in securing liealthful school- 
rooms aie proper heating and ventilation, seating, and lighting ; and 
it is to those topics that this paper is devoted. 

HEATING AND VENTILATION. 

I will take up first the subject of heating and ventilation, inst^pa- 
rable in our climate — a subject of prime importance, since hygienists 
are agreed that one-half the deaths are due to disease caused by im- 
pure air. 

In contrast to Dr. Phillips' observation in his locality, our Augusta 
school-houses are more apt to be over than under heated ; but I have 
not ol)scrved that this, in the rural districts, prompts to the opening 
of windows. When it does have this elfect, the rapid currents of 
air caused b}- dilferences of temperature, striking upon the chil- 
dren's heads, are not conducive to health. 

For the healthy ventilation of a school-room it is required that the 
air be changed four times an hour, and that it be done without caus- 
ing currents of greater rapidity than five feet a second. In cold 
weather, of course, the heating of the air is also involved 

Hygiene demands of a heating apparatus for the school-room : 

1. That there shall be attained, in a comparatively short time, a 
temperature of G")° — G8° F., and the temperature shall remain un- 
changed, so long as the children remain in the room. 

2. That the temperature of the room shall be as uniform .as po.s- 
sible in all parts, therefore the warming must not be by radiation 
but by conduction by means of the air (convection). 

3. That the air of the heated room must remain as mucii as pt»s- 
sil)le like the atmosphere, therefore it must not be imi)aired l>y the 
heating nor receive foreign admixtures. 

(273) 18 



274 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

4. That the heating appariitns must be easy to serve, its running 
free from danger, its first cost not too great, and the greatest possi- 
ble results must be attained from the fuel used. 

The attainment of most of the points depends on the form of 
heater used, and on the ventilation. 

Heating is divided into local and central. In local heating, the 
apparatus is placed in the room to be heated, and this is the form 
necessarily' to be used in most of our school-houses. 

The fire-place may be excluded as a means of heating school- 
liouses, although useful for ventilation, because its elfect is confined 
to its immediate vicinity' and is attained at a large expense in fuel. 

Some kind of stove is tlie only practicable form of local heater, 
buttlie common stove is excluded b}' our requirements, since it heats 
by radiation and does not promote an even temperature. 

A school-room heater should have an air space between the stove 
proper and an outside casing, like a furnace, through which air, 
brought in from out-of-doors through a box under the floor, should 
flow and conduct the heat through the room. Many forms of such 
heaters are in use in France aud German^^, and three at least are 
made in this countrj' ; but an ordinary cylinder stove can be pro- 
vided with an external casing and used in the same way. 

Central heating is where several rooms are warmed from a central 
source of heat, and is divided into hot air, hot water, and steam 
heating. 

If we imagine the already described school-room heater trans- 
ferred to the cellar and the licated air conducted by pipes to the 
room or rooms to be warmed, we have central hot air heating. If 
the furnace is large enough to furnish the needed amount of fresh 
air without over heating, and is so arranged that the heat is evenly 
distrilnited to tlie dillerent rooms, and is so carefully constructed 
that thci'e is no admixture ol" smoke or gases witli tlui air, this is a 
satisfactory and hygienic method of iK^atinj,'. Whatever appai'atns 
is used, it must furnish large volum(!S of air at a temixsraturc! little 
alK)ve tiiat at which it is desired to keep the rooms. Probably the 
Ituttan apparatus accompllsluiH this purpose hc^tter than any other 
form of air luiater. 

Of hot water heating it is unnecessary to speak in connection with 
school-liouses, but sleam licating is of wide a[)[)lic:iti()n. The heat- 
ing by direct radiation, as it is (tailed wlicue tli(! radiators are set in 
the room to he heated, is unequivocally to be condemned as a means 



HEALTHFUL SCHOOL-ROOMS. 275 

of beating school-rooms, since it makes no i)rovision for change of 
air ; it is snitablc only for the corridors. Tiie indirect method alone 
will do for a school-rooin, where the air is taken from oiit-of-doors, 
heated in boxes in the cellar which contain the radiators, and dis- 
cliargcd through registers into the room above. This mctliod has 
the advantage over that of the hot-air furnace, that the heat can be 
distributed over a large building, and, if pr()i)erly arranged, will heat 
all parts of it evenly ; and is preferable for a school-house of several 
rooms. 

Attempts have l)een made to admit the air from out-of-doors 
through the walls of the building into radiators set in the school- 
room, the so-called direct-indirect method. This may be, in some 
old buildings, the only practicable method, and if the opening is 
large enough and is situated near the bottom of the radiator, and 
the latter is large enough and is boxed at the sides, leaving the top 
open for the escape of the heated air into the room, ma}' accomplish 
very fair results. It is a great improvement on the unmodified direct 
method. 

Ventilation is the means by which normally constituted is put in 
the place of contaminated air. We cannot remove directly the prod- 
ucts of respiration from the air of a room, neither can we directl}' 
replace a given quantity of bad air with the same amount of good. 
The onh' way in which the quality can be improved is by the mix- 
ture of good air with the bad, diluting it ; just as in a cask filled 
with colored water and furnished with an inlet and an outlet pipe, if 
we allow a like amount of colorless water to flow in, it will not dis- 
place the whole of the colored, but we must pass in many times as 
much clear water I)eforc the outflow will be colorless. 

In order to bring pure air into a room, we must provide for re- 
moving the same (piantity of air from the room ; but the air removed 
is no more contaminated than that which remains, but is of a uni- 
form mixture with it. In no other way but by this constant mixing 
of pure air with the bad, and a constant removal of a portion of the 
mixture, can the air of a school-room be kept within the limits of 
health. This limit is represented by an increase of 2 parts in 10,- 
000 in the proportion of carbonic acid normally present. This sub- 
stance, being the most casil}' measured, and increasing in the same 
proportion as the other products of respiration, is used as an index 
of the contamination of the air. The expired air contains 200 times 
this increase, and as a man expires aliout 10 cubic feet of air an 



276 STATE BOARD OF HEALTH SPECIAL PAPERS. 

hour, there are needed 200x10=2000 cubic feet of fresh air an hour 
for each person. But in a school-room, which is not constant!}' oc- 
cupied, it is not necessar}' to introduce so much air, and about 750 
cubic feet per head an hour on an average is considered a fair 
amount, or a change of air four times an hour, if the room be of 
proper size. 

Difference of temperature is the important factor in natural venti- 
lation, for if the doors and windows of a room be wide open, and 
tlieie is no ditference of temperature and no wind, there will be no 
exchange of air between outside and in. 

Imagine frou) tiie bottom of the school-room a canal going to the 
cellar and there opening into a chimney Hue that extends above the 
roof ; also a canal from the open air entering the room ; let both 
these canals and the room lie filled with air of the same temperature, 
and the whole air column remains at rest. Now let the air in the 
chiraney-llue be warmed, it becomes lighter and rises, drawing after 
it air from the other parts of the system, the room and the enteiing 
canal. This is called aspiration, and the method aspiration-ventila- 
tion. Any of the methods described under heating will introduce 
fresh air into the room ; the warm air ascends immediatelv to the 
ceiling, where it spreads out, then cooled by the walls and windows it 
sinks to the floor, newl}' heated air taking its place. There is, how- 
ever, a constant mixture of the upper and lower strata, and it results 
from the law of the diffusion of gases that there is scared}' any dif- 
ference between the air of the different parts of the room, so that it 
makes no difference, from the point of view of ventilation, whether 
the outlets be at the top or the bottom of the room ; but if they are 
at the top they will remove the newly warmed air, causing great loss 
of heat without compensaling advantages ; it is therefore essential, 
at least in winter, that the outlets be in or near the floor. The inlets 
for warmed air may l)e in the floor or in the walls as most convenient. 

The ventilating flue may be heated by the smoke flue, being sepa- 
rated from it only by a thin wall, better b}' an iron smoke pipe pass- 
ing up through it, or, if necessary, by a small stov(; at its base. If 
steam be used for heating, the ventilating flues should be heated by 
steam-pipe. 

The siy(! of the f)penings and of the canals is to be [)ro[)ortioned 
to the amoiMit of air to l)e moved and the rapidity with which it 
flows. The latter should not Ik; greater than five feet a second. It 



HEALTHFUL SCHOOL-ROOMS. 277 

follows that the very common inlet or outlet opening of 1 square foot 
for 50 |)ii[)ils is insufrieiont ; three or four times that space is needed. 

If suitable methods are not provided for healing and ventilating 
the room, nature unaided will do niueli. The walls of our houses 
arc porous, and in a windy day with considerable dilference of 
tem[)erature this is an important factor. If the room be heated by 
a stove, the air consumed to supply the fire aids much in ventilation, 
as just so much fresh air must get into the room, through the walls 
and around doors and windows, to supply its place. So in a school 
of twenty pupils — and too many of our rural schools have less than 
this number — with an external temi)erature not much above zero antl 
an internal temperature of G5° F., the air will probably be kept in 
pretty good condition during the time the room is occupied contin- 
uously, if the windows be opened at recess and intermission. 

When it is found necessary to open windows during school hours, 
they should be provided with pieces of board to fit under the lower 
sash, or pieces set obliquely at the top if the upper sash is lowered, 
that the entering air may l)e directed to the top of the room. 

If the draft of the room is sufficient, a ventilating opening may 
be made directly into the bottom of the smoke flue, but this will 
usuall}- interfere too much with the draft. In an old building a 
wooden ventilating shaft may be built, extending through the roof, 
with an opening at the floor. The smoke pipe may enter this box, 
pass up it nearly to the I'oof and then turn and enter the chimney. 
AVith proper precautions against fire, this will be just as ellicient as 
a brick flue. 

One of the best practical evidences of impurity of the air of a 
room is the stully feeling it gives to a person coming in from the 
open air. As a [)ositive i)ro()f of contamination it is necessary to 
measure the i)roporli()n of carbonic acid present. This is done by 
finding the auKjuiil of carbonate of lime formed on shaking a meas- 
ured (piantity of the air with linu- water. Wolpert's Tester is a sim- 
I)le and convenient instrument for doing this, though not absolutely 
exact. 

SCnOOL-SEATS. 

Upon the (iiiestion of the proper construction of school-seats and 
desks, much of the interest in school hygiene has concentrated itself 
of late years, and the literature of the subject has become extensive. 
Since the source of si)inal curvature, near-sightedness, and a host 



278 STATE BOARD OF HEALTH — SFECIAL PAPERS. 

of other evils is believed to have been found in improper sitting, 
many new loruis of seats have been invented. 

The nieehanies of sitting is an interesting subjeet, but we laek 
time to enter upon it, and must be content with giving the practical 
results. 

The seat should be of the height of the bend of tiie knee, so that 
the feet may rest squarely' upon the Uoor ; and its width must be 
equal to the length of the thigh, but the forward edge must not reacli 
so far as to press upon the vessels and nerves behind the knee. 

The back of the seat is of vital necessity, since without its sup- 
port the body cannot be maintained in a proper position without 
constant muscular etiort. This support should be given at the right 
point ; for if the upper part of the back alone be supported, the spine 
will be bent forward and the thorax compressed. Support to the sa- 
crum is of primary importance, and the back should extend high 
enough to support the loins, and perhaps the lower part of the dorsal 
region. The back should start from the seat nearly perpendicularly 
and should acquire a backward curve as it ascends, following the 
curve of the spine. Man}' seats have the back concave at the lower 
part, so that support is lacking where it is most needed. I know of 
l)ut two makes of the "Combination" school seats with the proper 
curve to the back. 

The height of the desk should be proi)ortioncd to that of the seat, 
and their difference should l)e such that the fore arms can be laid 
upon the desk without raising the shoulders, or the edge of the desk 
should be at the height of the elbows of the sitting c;liild ; the desk 
will then be at the uornud sight-distance from the eyes. This matter 
of the difference in height of the seat and desk is very imi)ortant, 
for if the desk be too low, the ])ody will be bent in writing, and the 
head will be lowered to bring the eyes near enough for <;lear vision, 
with very injurious results ; while if the desk be too high, the shoid- 
d(;rs, arm, or l)Oth, will ))e raised, with great distortion of the spine, 
laming of the muscles, interlercuee with action of the heart and 
lungs, and injury to the eyes. 

The distance of the desk is of great importance, that is, the dis- 
tance between vertical lines falling from the edge of the desk and 
the edge of the seat. This is of three kinds : Plus-distance, where 
there is an actual di.stancc between the lines ; zero-distance, where 
the edges of the desk and seat are in the same vertical line ; and 
minus-distance, where the edge of the desk overhangs that of the 



HEALTHFUL SCHOOL-FiOO.'MS. 279 

seat. The miniis-distauce is that now accepted as the most advan- 
tageous for the pupil, and the best preventive of faulty positions in 
writing. The amount of overlapping is given as from 1 to 2| iuches. 

The objection has been raised to the zero, or minus-distance desks, 
that they do not permit, the i)upil to stand in front of his seat. With 
single or double desks, whicii are now everywhere used in this coun- 
try, pupils can better stand in the aisles between the rows of desks. 

The desk shoidd have a slope of 2 inches in 12, making the angle 
of vision about 00°. A greater slope would be more favoraI)le to 
the eyes, but is inconvenient. 

Having consiilorcd the hygienic re<|uirements of school furniture, 
let us see how their reijuiremcnts are mel. 

Besides the old forms of de^ks and benches that are still found in 
most of our rural schools, and that violate in every res[)ect the prin- 
ciples of hygiene. American sciiool furniture — and in this specialty 
we are far in advance of all the rest oi' the world — is divided into 
two general classes, the '-lioston" and the "Combination" patterns. 

The Boston furniture consists of a desk sup[)ortetl on a piece of 
ornamental cast iron woik at each end, and a chair supported by a 
cast iron pedestal under the seat. It has the advantages that the 
seats and desks are independent, and desks of different heights can 
be set in the same row ; and that the pupil can enter or leave the seat 
more easily than with other kinds. It has the disadvantage that the 
screws that fasten the chair to the lloor are very ai)t to become loose, 
owing to the great leverage furnished by the chair in proportion to 
the small surface standing upon the lloor; and the chairs are not so 
comfortable as the best tjombination seats. 

The combination furniture is so called because a seat is combined 
with a desk, not with its own desk, but with the one behind it ; hence 
two sizes must not be set in the same row, otherwise a seat and desk 
not proportioned to each other will come together. The seat is usually 
hinged so that it can l)e turned up, leaving standing room behind the 
desk ; but this is of doubtful utility, except in sweeping the room. 
Both these kinds of furniture can be set at i)lus, zero, or minus dis- 
tance. 

Much ingenuity has been expended in constructing tilting seals that 
will automatically tip up when the pupil rises. These are dangerous, 
from the liability of the pupil to forget that the seat is raised, and 
to injure himself by ^itting forcibly upon its edge or on the floor; 



280 STATE BOARD OF HEALTH — SPECIAL PAPERS. 

the}' are objectionable from being necessarily more complicated ; and 
they are unnecessary', for reasons already given. 

As already stated, most of the combination furniture has faultii}'- 
shaped backs, and only two makes, so far as I know, are to be com- 
mended. 

Considering everything, j'^^'o and con, it is difficult to decide which 
has the balance of advantages in its favor, the Boston or the best form 
of the combination furniture ; but the former is clearly superior to 
three-fourths of the combination furniture in the market. 

Whatever kiud of furniture is used, two or more sizes should be 
included in each room, and the teacher should see to it that each 
pupil has a seat and desk proportioned to his height. 

Elaborate tables have been constructed, giving all the dimensions 
of seats and desks for every given height of the pupil ; but the few 
simple rules alrcad}' given are suflicient for the proper seating of 
pupils. The results arrived at, from many observations, are formu- 
lated as follows : 

1. The height of the seat=2-7 the body height. 

2. The width of the scat=l-5 the body height. 

3. The distance==l-7 the bod}' height. 

4. The width of the dc8k^l5-18 inches, 

5. The slope of the desk^2 inches in 12. 

LIGHTING. 

One of the commonest unfavorable results of school life is injury 
of the eyes. Near-sightedness is very rarely hereditary. When it 
exists, it has almost always been acquired while attending school ; 
and numerous examinations, botli in this country and abroad, prove 
that it shows a steady increase as we go from lower to higher grades 
of school. 

One cause of this has been already indicated in the faulty construc- 
tion of school furniture; but a far more fruitful source is found in 
insufficient and imi)roper liglitiug. It is safe to say that not one school- 
room in fifty, in our State, is properly lighted. The suitable ligliting 
of a school-room demands : 

Ist. That the windows face that part of the sky which affords a 
suitaVjlc light. 

2d. That the daylight be kept from the room 1)y no obstructions. 

3d. That the windows be of proper height and width. 



HEALTHFUL SCH00L-K003IS. 281 

4th. That the windows 1)C properly arranged. 

5th. That the interior arrangements be sueh that tlie liglit is siiit- 
al)ly distributed. 

1st. If the light conies from the east or south it will be impossible 
to exclude the direct rays of the sun from the ilesks without making 
the light insullicient. Every room should, however, receive the direct 
rays of the sun for some part of the day. For this reason lighting 
from northeast or northwest is preferal)lc, giving reflected light only 
during school houis, but permitting the access of direct sunlight before 
or after school. 

2d. The free access of light to the school- house depends upon the 
nature of its surroundings. No l)uilding should be so near the win- 
dows as to cut olf more than 20° or 25° of the sky above the hori- 
zontal line of the window sills, which requires that it be distant about 
2| times the height above this line. High and shady trees should 
not be allowed near the windows, neither should vines be trained 
about them. 

3d. The fullest supply of light about the school-house is self-evi- 
dently useless unless there be sufficiently large and numerous o^ien- 
ings for its admission to the school-room. The windows must be as 
high and wide as practicable. The window stools should be 3| or 
4 feet from the floor, that the light may strike downward upon the 
desks ; and the top should extend to, as nearly as possil)le, within six 
inches of the ceiling. The windows should be arranged in a long side 
of the room, not grouped, but distributed evenly nearly its whole 
length, and their width should be such as to provide a sullicient glass 
surface for the size of the room. In the open country, a glass sur- 
face equal to 1-6 the area of the floor is enougii, but in a city 1-5 or 
more will often be required. 

4th. One who undertakes to write with the light coming from the 
right hand will be annoyed by the shadow of the hand falling upon 
the i)apcr at the very si)ot where he is writing. On this .-simple fact 
depends the necessity that school-rooms be lighted from the left hand 
of the pupils, as so much school work is now done with the pen and 
pencil that the direction of the light has become of great importance. 

The worst light is that from in front, its rays falling directly into 
the eyes of the pupils and scared}' at all illuminating their desks. 
If your school-room has a window facing the i>ui)ils, keei) its shades 
constantly closed. 



282 STATE BOARD OF HEALTH SPECIAL PAPERS. 

Lighl from behind alonu is unsuitable, since the i)upil's work 
would be in the shade ol' his body, but light fioni the leiir in combi- 
nation with that IVom the left is not objectionable. 

Lighting from both sides is ver}' undesirable, although it may be 
necessary to continue it in many old buildings Avhen the width is 
greatly out ol" proportion to the length. In new buildings it should 
never be used, because by the casting of shadows and a peculiar 
reflectiou it is liable to prove injurious to the eyes of pupils. 

5th. The walls of the school-room should not be white, since they 
would reflect the light too intensely, nor loo daik, since they would 
absorb too much light. The best color is a bluish gray, what is known 
as a light French gray. The ceiling may be while, since the rays of 
light cannot strike it in such a way as to he injuriously rellected upon 
the desks, or blue. The window shades, if any, should be blue or 
gra^', and the wood work, if jiaiuted, about the color of the walls, of 
a darker shade. 

To recai)itulate. 1st, lighting from the northeast or northwest; 
2d, no obstruction to access of light ; od, glass surface 1-G to \-') the 
lloor surface, the windows of [)ro[)er height; ith, lighting always 
from the left of the pupils, or left and rear ; 5th, walls neither white 
nor too dark. 

But however perfect the light, eyes may and will be injured if fixed 
upon a book long at a time. When a(lai)ted to near vision, the nor- 
mal eye is in a state of tension, and should be rested Ity looking, at 
frequent intervals, at objects not less than twenty feet distant. Much 
injury is constantly done V)y teachers in reipiiring uninteruiitting atten- 
tion to books, and "no looking aroimd." 

In this, as in many other matters, teachers are capal)le of tloinga 
great deal of harm, unless they be students oi hygiene and apply its 
principles in their daily work. 



Summer Resorts, 



BY TIIK SECRETARY. 



TIk! SliiLe l>();ii'(l of IlcalUi is pleased Lo nuto and iiiuiiUon a special 
awakening to the ini[)ortancc and weight of sanitaiy obligations on 
the part of proprietors of places for summer resorts, and of towns 
where the attractions of scenery and climate serve to bring a large 
summer po[)ulation within their borders. The coming of these vis- 
itors annually is such a source of rcveuue to our State, that legisla- 
tion is beginning to shape its policy to satisfy their proper wants, 
and to give to these resorts a protection which shall become a safe- 
guard and shall lead to more extensive development and to perma- 
nent good lesults. It is rare that towns can be aroused to act in the 
matter of a good and [)lenteous water supply and sewerage system, 
until bitter experience has taught a sad lesson, and then the estab- 
lishment of the once favorite resort in i)ublic favor is slow, and in 
many cases fails entircl}' notwithstanding the original sources of 
dilHculty have been removed. With exceptional attractions, as at 
Bar Harbor, Mt. Desert, the place may struggle through to success, 
as that resort is now doing, because the island has published to the 
world that her sanitary' provisions are to be of the best, and are now 
ap[)roaching completion under the hands of a sanitary engineer of 
national reputation and experience. We shall note her progress in 
our next Rei)ort. Old Orchai'd has made extensive moves in sewer- 
age, and is this season introducing a more extensive water supply. 
A general activity in these directions is everywhere manifest. The 
proprietor of an isolated and independent summer resort, if he is wise, 
realizes the value of these measures to promote health and acts upon 
them even more rapidly and elliciently than the slower moving body 
of a town. It is of such proprietors and of such a summer resort 
that the accom[)anying illustration treats. 

Poland Springs, from being the resort ol invalids who go there to 
recover health, has also become Maine's largest interior summer re" 

(283) 



284 



STATE BOARD OF HEALTH — SPECIAL PAPERS. 



sort. Anticipating its growth, its proprietors, in the season of 1885, 
had their opi)ortiinities looked into, and then a system of drainage 
executed under advice of a sauitary engineer, as shown on the con- 
tour plan. The site of the Poland Sjjring Hotel, on the summit of a 
rounding hill, made the problem of getting effective drainage a sim- 
ple one. A short-sighted economy might have brought the sewage 
in iron i)ii)es down the east sloi)e of the hill 1000 feet away, and 100 
feet in elevation l)elow the spring, making an undoubted sanitary 
success, but a proi)er regard for certain strong sentiments in the 
public mind led the proprietors to carry the sewerage down the hill 
upon the direct ojrposite side from the one upon which the spring is 
located. The out-fall of the sewer is upon farm lands of the propri- 
etors, 3000 feet from the Poland Spring House, at which point utili- 
zation in irrigation is partially arranged for, and which we tliink could 
with profit be made more thorough. The conditions under which 
the sewage runs to waste upon unused land makes no nuisance, and 
this fact, as we learn from the proj)rietors, together witli the labor 
problem of providing for increasing number of guests, has delayed 
the thorough organization for utilization. 

Among the simple but very efTective ap[)liances that attracted our 
attention, was a switch man-hole for turning the sewage from one 




v-e/i^.?^ /a»6o\.^ 



Hole 



Switch Mi 
A B^AC.OhAO veprasent fizazs oj vitx"e^ieoLrs«w/M']iiip» 

piece A B 73 TaTrioyaTjl«/ 
T)i* samC' CUTtf^d ^)^vv.^. lact-n. be usael an positions /^C'¥'/l D 

place of disposal to another. This, in many cases, has been accom- 
plished by expensive water-gates, built in the wall side by side. The 



SUMMER KESORTS. 285 

projecting edges frequently collect rags, paper and general waste, 
and a stoppage aiul damage occurs. The plan of the one presented 
is made as follows : on the straight line through the man-hole is a 
length of sewer pipe willi top surface removed. Its bed at the two 
ends is formed in the cement. In the man-hole is stored a curved 
piece of pipe of the same size, the bed for whicii outside of the limit 
of the straight piece is also formed in the cement. The straight 
piece is removed, and the curved piece dropped in its own socket to 
deliver the sewage to the right or left, according as you turn the 
curved piece end for end. This switch man-hole, which cost only 
!$15 to construct, is far more satisfactory than one noted elsewhere, 
with gates, that must have cost $100. 

As remarked above, we have been i)leased to note the general 
advances that have been made in sanitary provisions at our summer 
resorts, and as we do not hesitate to condemn unsanitar}- conditions, 
we stand ready to commend such as wo deem worthy of approval. 



GLOSSARY. 



This Report Las been prepared for the benefit of all classes of persons in the State, and as 
far as possible it has been the wish to make its lanjjuage as clear and intelliLjible as possible. 
A few technical terms, liowever, are so inseparably interwoven into the consideration of the 
subject of public livfjiene that the avoidance of their use is impossible, and as it is desirable 
that the general public should become acquainted with their meaning, and especially to 
know in what sense they are used in the present work, this Glossary is introduced. 



Etiology. [See Etiology.] 

Antiseptics. Agents which prevent or retard putrefaction ; or as now 
understood, those which prevent tlie development of pathogenic or 
fermentative organisms. Some of these which, in weaker solutions, 
act as antiseptics, in stronger solutions, being destructive of the life 
of the organisms, are also disinfectants. 

Bacilli. The plural of bacillus. 

Bacillus. One group of bacteria which are filiform, or consist of slender 
rods. 

Bacillus Anthracis. The bacillus of anthiax, the essential cause of tht; 
disease. 

l?acteria. Unicellular Organisms, microscopic, in si/e, on the hordci- land 
between the vegetable and the animal klMgdoni, but now regarded as 
pcrtaiiuiig to the former. 

Bacterium. The singular of bacteria. 

Biology. The science ot life. 

Bovine Virus. Vaccine virus taken directly from the calf or iieifer. 

Contagion. Tlie specific cause of certain diseases hy means of which 
they may be transmitted. Also applied to the act of transmission of 
communicable diseases. 

<Jontagious. Capable of being transmitted by contagion ; communi(*able; 
infectious. But little elVort has been made in this Report to discrimi- 
nate between the meaning of Contagious and Infectious; altliougli 
tiieir derivation and original applictation were different, most of tlie 
later medical writers of Kuropi; aiul America nsc^thc; two words inter- 
(•iiaiigeably. This, at least in works for po])nlar use, is the less con- 
fusing way. 

Deodorants. Substances which destroy ollensive smcdls. Some, but not 
all deodorants, are also disinfectants. [See Disinfectants.] 

Desquamation. The shedding of the outer skin, usually in scales, after 
scarlatina and some other diseases. 

Diagnosis, 'i'hf determination of the character of a disease, 

(28G) 



GLOSSARY. 287 

Disease Germs. Bacteria; uiioro-oigaiiisms whose reception into tlie 
system ami multiplicution in it. produce the contagious diseases. 

Disinfectants. Agents or substances by means of which the contagion of 
diseases may be dostro}-ed. Often improperly applied to substances 
which, though useful as deodorants or antiseptics, are nearly or (juite 
valueless as germicides. 

Endeinic. Applied to diseases which prevail in particular localities or 
districts, and which are due to local conditions or causes. 

Epidemic. (Common to, or affecting many people at the same time; 
generally prevailing. The causes of epidemics were formerly very 
generally regarded as depending upon an "epidemic constitution of 
tlie atmosi)here," but of tliis there lias never been collected any satis- 
factory proof. The more we study epidemiology the more we are led 
to look to contagion and the laws which govern its diffusion for an 
explanation of the occurrence of epidemics. 

Epizootic. Applied to the diseases of animals in the same sense as epi_ 
demic is used witli reference to human diseases; affecting many ani- 
mals at the same time. 

Etiology. The causation of diseases. 

Exogenous. Produced or generated outside the system. 

Exotic. Foreign ; a disease introduced from some other countrj'. 

Fission. Division; the common method of multiplication with many of 
the lowest organisms. 

Fomites. .Substances or articles wiiich are liable to carr}' th(^ contagion 
of diseases. 

Germicides. Destroyers of germs ; disinfectants. 

House-drain. Tliat part of the house-drainage system which carries the 
wastes from the soil-pipe and waste-pipe to the sewer. 

Humanized Virus. Vaccine virus taken from tlie cow-pox vesicle which 
has been produced on the human arm, usually the arm of a child. 

Hygiene. Tiie science and art relating to the preservation of health. 

Infection. Contagion; the specific cause of comiuunicable diseases, now 
known in some diseases, and supposed in others, to be a microscopic 
organism. 

Infe<'tious. Coniniiinicabl»» as a disease; contagious. [See Contagious.] 

Microbe. Iiac;terium. 

i\lierococcus. A genus of tlic bacteria, consisting of very small, globu- 
lar or ov.al, organisms. 

Pathogenic. Generative, or productive of disease. 

Pathological. Pertaining to pathology ; diseased. 

Pathology. Tiie knowledge of diseases. 

Piithisis. Consumption; pulmonary tuberculosis. 

Physiology. Tiie science whif^h treats of the functions of living animals 
or plants. 

Prognosis. Tlie prediction, from the present symptoms of a disease, of 
its future course or termination. 



288 GLOSSARY. 

Quarantine. Tlie enforced isolation of persons and things coming either 
by sea or land from places where contagions diseases exist. 

Sewage. The liquid and other lilth conveyed in sewers. 

Sewer. A drain for conveying dirty water and lilth. 

Sewei'age. A system of sewers. 

Soil-pipe. The pipe which conveys excreta from water-closets and 
urinals. 

Sporadic. Applied to diseases, it means occurring in single or scattered 
cases, as opposed to epidemic or endemic, in which numbers or many 
are afl'ected. 

Spores. Minute grains oi- bodies which are formed within many of the 
lower tlowerless plants, and which perform the function of seeds. 
Tlie microscopic one-celled plants which we call bacteria multiply 
by fission, and in addition to this, some of them nniltiply by means 
of spores. 

Sporification. Tlie fornnxtion of spores. 

Tellural. Pertaining to, or proceeding from, the earth. 

Trap. An arrangement on some part of the sewerage system, usually a 
bend in the pipe in which water stands, by means of which we seek 
to prevent the return of gases and disease germs into the building. 

Tuberculosis. A specitic disease usually characterized by the formation 
of tubercles. Pulmonary consumption is the result of tuberculosis of 
the lungs. 

Typhoid Fever. Meaning literally a fever resembling typhus. The 
common fever of this country. Formerly typhus fever and typhoid 
were not distinguished, the one from the other. Typhoid fever is 
comnmnicable only in a slight degree, if at all, by direct contagion; 
l)ut tlicre is great danger of its spread from the sick to the well from 
defective sanitary arrangements and regulations. 

Typhus Fever. A dangerousl}' contagious disease rarely found in tiiis 
country, and when api)earing in our State, i)rohiihly always l)y im- 
portation. [See T'yphoid Fever.] 

Vaccination. Inoculation with the virus of cow-pox. 

V^accine Virus. The infective material from the; cow-pox vesicle used in 
vaccination. 

Variola. Small-pox. 

Varioloid. Small-pox modilicd by vaccination. It is contagious, and as 
severe cases of small-pox may arise from exposure to its iidiiction as 
from umnodilled small-pox. 

Waste-Pipe. 'I'liat part of the system of house-drainagti whieli conveys 
the waste-water from siidvS, baths, (!tc. 

Zymotic. (;haracteri/ed by fernuMitation. ApplicMl to epidemic, end(unic 
and contagious disfiases, on account of the similarity between the 
process of fiirmentation and that whicii is startcnl in the organism 
after its infection with the cause of any of these diseases. 



INDEX. 



PAGE. 

Actinomycosis 52 

Allen's Corner, diphtheria at 115 

An Act to Establish Local Boards of Health '.» 

Ancient sanitary law, illustration of a 

Animal and human tuberculosis, relation of 241 

Animal diseases, pecuniary losses from 41 

Animals, contagious and parasitic diseases of. 40 

Anthrax 50 

Arsenical poisoning 103, 132 

Artesian wells 202 

Bacillus tuberculosis 141, 237 

persistent vitality of the spores of 142 

disinfectants for 144 

artificial cultivation of 238 

Bailey, Dr. G. H., report to Legislature 21!> 

Bang on udder tuberculosis 245 

Bangor, milk poisoning in 1C3 

Bar Harbor, sanitary questions in 3!i 

Billings, Dr. F. y., opinion of. 244 

Bisulphites 153 

"Blue Solution" 15S 

Bollinger, experiments of 245 

opinion of 24S 

Bovine tuberculosis 219 

from an economic and sanitary point of view . . . 255 

Brieger, late experiiuents of 171 

Brewer, visit to 39 

Brunswick, diplitheria and other diseases in 24 

death-rate in 28 

report to Local Board of Health of 2(; 

Canton, diphtheria in 21 

Carbolic acid 151 

solution in oil without value as a disinfectant 152 

Carbuncle 50 

Cattle plague 52 

19 



290 INDEX. 

PAGE. 

Cliarbon 50 

Cheese, milk and ice cream poisoning 163 

Childhood, susceptibility of, to the zymotic diseases 31 

Chimneys, not to be used as ventihators for soil pipes 193 

Chloride of lime 153 

Chloride of zino 152 

Chlorinated soda 153 

Circulars 40 

Cistern water 198 

Clothing and bedding, disinfectants for 160 

Committee on disinfectants 151, 158 

Committees 2 

Comparative value of negative evidence as to the non-contagiousness 

of diseases 148 

Comparative view of sanitary laws 261 

Consumption, contagiousness of 94, 137 

answers from physicians concerning, 

137, 138 

cases illustrating the contagiousness of 139, 140 

most frequent mode of infection 143 

prevention of contagion 143 

Contagion, the personal element in 150 

Contagious and parasitic diseases of animals 40 

Contagious diseases, individual susceptibility to 150 

laws regarding 270 

restriction of, in Michigan 187 

Corpses, transportation of 181 

Corrosive sublimate 153 

Danger from the llesh and milk of tuberculous animals, 

243, 244, 245, 246, 247, 248, 249, 250 

Dead, disinfectants for the 161 

Death-rate in Brunswick 28 

Dcering, inspection of nuisance in 36 

Diarrhceal diseases and water pollution 96, 126 

nursing bottles 93, 103, 116, 124, 133 

Diphtheria at Allen's Corner 15 

and other diseases in Brunswick 24 

communicated at a funeral 81, 103 

from infected clothing 15, 81 

unsanitary conditions 75, 128, 124 

contagiousness of. 93, 111 

good results of efforts at restriction of 21 

in animals 52 

Canton 21 

East Madison 18 

Infectiousness of mild cases of 19, 86, 146 



INDEX. 291 

PAGE. 
Diphtheritic infection, persistence of vitality of, 

18, 68, 75, 80, 82, 92, 111, 129 

Disinfectants, notes on 151 

Disinfectant solutions 157 

Disinfectants for excreta 150 

clothing, bedding, etc IGO 

furniture, articles of wood, etc 160 

the person 161 

the dead 161 

the sick-room 161 

merchandise and the mails 161 

rags 162 

ships 162 

East Madison, diplitheria in 18 

Eastport, ice cream poisoning 168 

Ergotism 49 

Excreta, disinfectants for 159 

Expenses of the Board 66 

Fairfield, typhoid fever in 34 

Filter, construction of 205, 206, 207 

Filter galleries 201 

Filtration, central 205 

peripheral 206 

Filtration of water 204 

Fish poisoning 168 

Fleming, opinion of, regarding tuberculous milk 243 

Flesh and niilk of tuberculous animals, danger from, 

243, 244, 245, 246, 247, 248, 249, 250 

Foot-and-mouth disease 48 

Foot-rot in sheep 49 

Fowl cholera 51 

Fresh-air inlets 194 

Furniture, disinfectants for 160 

Gapes 51 

Garbage furnace, at Governor's Island 178 

at Wheeling, W. Va 170 

in Toronto and Montreal 179 

Garbage furnaces 171 

Gardner, J. T., on ice from impure water 208 

Gerlach, opinion of 244 

Germs, methods of multiplication 151 

Glanders 41 

Gorliam, visit to Normal School 39 

Governor's Island, garbage furnace at 173 

Grad, observations of 229 

Ground water 199 

Hard water 207 



292 INDEX. 

PAGE. 

Healthful school-rooms 273 

Heat, degree of, fatal to bacillus of tuberculosis 259 

drj', as a disiufectant 155 

moist, as a disiufectant 155 

Heating and ventilation 273 

Heredit)', as a cause of tuberculosis 251 

H^vdropliobia 50 

Hj'posulphites 153 

Hog cholera 46 

Ilorr, Dr. O. A., on garbage furnaces in England 173 

House drain, material for 192 

Ice cream poisoning 163 

Ice. impure 208 

Infectious diseases, inter-state notification of 188 

sanitarj' significance of mild cases of 144 

Inoculation of tubercle 238 

Inter-state notification 188 

Jamm, observations on contagiousness of tuberculosis 228 

Johne, Dr. Albert, opinion of 244 

experiments of 245 

Klebs, experiments of 246 

Kocli, Dr. Robert, on cause of tuberculosis 227 

experiments with disinfectants 151 

inoculation experiments of. 238 

inhalation experiments with pure cultures 239 

Labarraque's solution 153 

Lake or pond water 202 

Lead poisoning 74, 76, 115, 118, 131 

Leucomaines 168, 171 

Liljrary 56 

Lighting 280 

Li(jiior soda) clilorinatae 153 

Local Boards of Healtli in tlie various States 265 

qualifications of 6 

powers and duties of 10 

Local sanitary work in Minnesota 184 

Lung worm disease 46 

Malignant jtustuie 50 

Meat poisoning 107 

Medical correspondents, reports from 67 

Membership of the Hoard 1 

Merchandise and the mails, disinfectants for 161 

Mercuric chloride 153 

Milk, danger from tuberculosis 214, 245, 216, 247, 248 

unwholesome 35, 77 

Naples, former decrees in, respecting consumptives 138 

National Conference of State Boards of Health, report of meeting.. 180 



INDEX. 293 

PAGE. 

Xegative evidence, value of. 148 

Norway, visit to 37 

Notes on (lisinfcttants 151 

Nuisance, inspection of, in Deering 36 

Nuisances, laws concerning 268 

Nursing bottles and dianhceal diseases 93, 103, 116, 124, 133 

Orth, opinion of. 249 

Other kinds of poisoning 167 

Person, disinfectants for the 161 

Pleuro pneumonia 43 

inoculation for 44 

Plumbing of the new Capitol of Indiana 189 

Poland Springs, sewerage of. 283 

Portland, report of work of Local Board of Health of. 114 

Potassium permanganate 153 

Ptomaines 164, 168 

Pure cultures 239 

"Purple solution" 157 

Rabies 50 

Rags, disinfectants for 162 

Rain water 198 

Reilley, Lieut , letter from 175 

Relation of animal and human tuberculosis 241 

Report to Local Board of Health of Brunswick 26 

Rejwrts from medical correspondents 67 

Rinderpest 52 

River water 203 

self-purification of 203 

"Rouget"' 47 

Sanitary law, results of defective 23 

Sanitary laws, a comparative view of 261 

Sausage poisoning 167 

Scarlet fever, from contagion 79, 109, 110, 149 

prolonged vitality of contagion of 82, 119, 125, 128, 135 

contracted at a funeral 98 

from a letter 128 

Schill and Fischer, on carbolic acid 152 

School-rooms, healthful 273 

heating and ventilation of 273 

lighting of 280 

School seats 277, 279 

Secretary's Report 1 

Sewerage of Poland Springs 283 

Sheei>-pox 49 

Shell-lish, poisoning from 168 

Ships, disinfectants for 162 



294 INDEX. 

PAGE. 

Sick-room, disinfectants for the 161 

Small-pox, from infected gloves 99 

Solutions, disinfecting 157 

Splenic fever 50 

Spores, note explanatory of 151 

Spring water 199 

Sputum of consumptives, infectiousness of 1 42, 143 

Stang, Dr., case reported by 248 

State Boards of Health, laws establishing 263 

State College, Orono, tuberculosis at 219 

Sternberg, experiments of 151 

Sulphate of copper 152 

Sulphate of iron 152 

Sulphate of zinc 152 

Sulphites 158 

Sulphur fumigation 156 

Sulphurous acid. 156 

Summer resorts 283 

Swill milk 77 

Swine plague 46 

Tests for impure water 210 

Treatment of the drowned 53 

Trichinae 47 

Trichinosis 47 

Tuberculosis and pleuro pneumonia, points of resemblance 45 

bovine 219 

cases of, illustrating contagion 220, 228, 229, 231 

cases illustrating how it may be transmitted from man 

to animals or vice versa 241, 242, 243 

character and nature of. 225 

how it is communicated 240 

preventive measures for 258 

causes other than contagion and heredity 254 

congenital 25H 

prevalence of. 255 

symptoms of 22;5 

the identity of animal and human 139, 220, 240 

Tuberculous sputum, infectiousness of 142, 143 

Typhoid fever and water pollution 32a, 70, 85, 88, 90, 119 

in P'airfield 34 

in Van Buren 31 

in other towns 33 

from poisonous gases 112 

from unsanitary conditions 113 

Tyrotoxicon 104 

Van Buren, typhoid fever in 31 



INDEX. 295 

PAGE. 

Various sanitary topics 137 

Vaughan, Dr., investigation of cheese poisoning 164 

Ventilation 273 

volume of air required for 276 

size of outlets and inlets for 277 

by means of windows 277 

Verminous bronchitis 46 

Walley, Prof., opinion of 244 

Warren filter 213 

Water, chemical purification of 207 

cistern 198 

distribution of 204 

filtration of 204 

hard 207 

impure, effects of 209 

kinds ot 197 

lake or pond 202 

rain 198 

river 203 

spring 199 

well 199 

pollution and typhoid fever 32a, 34, 70, 85, 88, 90, 119 

and diarrha?al diseases. 95, 126 

supply, public and domestic 197 

amount to each inhabitant 197 

Well water 199 

Wells, area of soil drained by ... : 200 

Wheeling, W. Va., garbage furnace at 176 

Willard Asylum, tuberculosis at 246 



COLUMBIA UNIVERSITY LIBRARIES 

This book is due on the date indicated below, or at the 
expiration of a de&iite period after the date of borrowing, a^ 
provided by the library rules or by special arrangement with 
the Librarian in charge. 



DATE BORROWED 


DATE DUE 


DATE BORROWED 


DATE DUE 


































































































































C28(842)K 


1 (O